RESUMO
BACKGROUND: Tumor lysis syndrome (TLS) and its most serious complication, acute kidney injury (AKI) are one of the emergency conditions in onco-hematology. It is difficult to predict the degree of kidney involvement. Therefore, we studied children with leukemia and lymphoma treated in four Hungarian tertiary centers (inpatient university clinics) retrospectively (2006-2016) from a nephrological aspect. METHOD: Data of 31 pediatric patients were obtained from electronic- and paper-based medical records. Physical status, laboratory test results, treatments, and outcomes were assessed. Patients were analyzed according to both "traditional" TLS groupings, as laboratory TLS or clinical TLS, and nephrological aspect based on pRIFLE classification, as mild or severe AKI. RESULTS: Significant differences were found between the changes in parameters of phosphate homeostasis and urea levels in both classifications. Compared to age-specific normal phosphate ranges, before the development of TLS, hypophosphatemia was common (19/31 cases), while in the post-TLS period, hyperphosphatemia was observed (26/31 cases) most frequently. The rate of daily change in serum phosphate level was significant in the nephrological subgroups, but peaks of serum phosphate level show only a moderate increase. The calculated cut-off value of daily serum phosphate level increased before AKI was 0.32 mmol/L per ROC analysis for severe TLS-AKI. The 24-h urinalysis data of eight patients revealed transiently increased phosphate excretion only in those patients with TLS in whom serum phosphate was elevated in parallel. CONCLUSION: Daily serum phosphate level increase can serve as a prognostic factor for the severity of pediatric TLS, as well as predict the severity of kidney involvement. A higher resolution version of the Graphical abstract is available as Supplementary information.
Assuntos
Injúria Renal Aguda , Leucemia , Linfoma , Síndrome de Lise Tumoral , Humanos , Criança , Síndrome de Lise Tumoral/etiologia , Síndrome de Lise Tumoral/complicações , Estudos Retrospectivos , Leucemia/complicações , Linfoma/complicações , Linfoma/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/complicações , Fosfatos , RimAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Sulfonamidas/efeitos adversos , Síndrome de Lise Tumoral/etiologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Citarabina/uso terapêutico , Decitabina/administração & dosagem , Feminino , Hidratação , Humanos , Hidroxiureia/uso terapêutico , Incidência , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/genética , Leucemia Mielomonocítica Aguda/complicações , Leucemia Mielomonocítica Aguda/tratamento farmacológico , Leucemia Mielomonocítica Aguda/genética , Leucocitose/tratamento farmacológico , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Proteínas de Ligação a Fosfato/uso terapêutico , Fósforo/sangue , Proteínas Proto-Oncogênicas c-bcl-2/antagonistas & inibidores , Estudos Retrospectivos , Sulfonamidas/administração & dosagem , Urato Oxidase/uso terapêutico , Ácido Úrico/sangueRESUMO
Myocardial calcification, a rare disease that leads to chronic or acute heart failure and with a poor prognosis, occurs in patients with abnormal calcium-phosphorus metabolism. The association between myocardial calcification and tumor lysis syndrome has not been reported to date. A 50-year-old man with hyperthermia and general malaise presented to our hospital and was clinically diagnosed with B-lymphoblastic leukemia (B-ALL) and febrile neutropenia accompanied by septic shock. Prednisolone was administered for tumor reduction. Two to three hours later, electrocardiography demonstrated ST elevation in V4-6, and blood tests showed elevated levels of cardiac enzymes. Transthoracic echocardiogram revealed diffuse severe hypokinesis with decreased left ventricular ejection fraction. Additionally, blood tests showed that serum phosphorus level increased to 8.0 mg/dl, which was likely due to tumor lysis syndrome. Circulatory and respiratory failure due to left heart failure progressed, and he died 3 days after administration of prednisolone. Pathological autopsy revealed diffuse proliferation of atypical B-lymphoblasts in the bone marrow, which led to the pathological diagnosis of B-ALL, accompanied by necrosis. On the cut surface of the heart, the left ventricle was dilated, and patchy yellowish-brown areas were present in the epicardial-side of the myocardium and spread through the circumferential wall of the left ventricle and interventricular septum. Microscopically, myocardial fibers were granularly basophilic in that area and were revealed as calcium deposits by Von Kossa staining. He was diagnosed with myocardial calcification. The drastic increase in the serum phosphorus level caused by tumor lysis syndrome seemed to be associated with myocardial calcification.
Assuntos
Antineoplásicos/efeitos adversos , Calcinose/etiologia , Cardiomiopatias/etiologia , Miocárdio/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Prednisolona/efeitos adversos , Síndrome de Lise Tumoral/etiologia , Autopsia , Biomarcadores/sangue , Calcinose/sangue , Calcinose/patologia , Cardiomiopatias/sangue , Cardiomiopatias/patologia , Causas de Morte , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/metabolismo , Fósforo/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Síndrome de Lise Tumoral/sangue , Síndrome de Lise Tumoral/patologia , Regulação para CimaAssuntos
Carcinoma Hepatocelular/complicações , Leucemia Mielomonocítica Crônica/complicações , Neoplasias Hepáticas/complicações , Síndrome de Lise Tumoral/etiologia , Antineoplásicos/efeitos adversos , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Óleo Etiodado/efeitos adversos , Humanos , Leucemia Mielomonocítica Crônica/tratamento farmacológico , Leucemia Mielomonocítica Crônica/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Síndrome de Lise Tumoral/patologiaRESUMO
BACKGROUND: Tumor lysis syndrome is an oncologic emergency due to the release of tumor cell contents, leading to metabolic derangements. Rasburicase, a recombinant urate oxidase, catabolizes uric acid. At our institution, we administer a single 6-mg dose of rasburicase to patients who are at risk for tumor lysis syndrome. We aimed to assess the efficacy of single 6-mg dose of rasburicase and explore risk factors associated with rasburicase failure. METHODS: We report results in 92 adult patients who had a baseline uric acid greater than 7.5 mg/dL and received a single 6-mg dose of rasburicase for the management of tumor lysis syndrome. Responders were defined as those whose uric acid was less than or equal to 7.5 mg/dL within 24-36 h of rasburicase administration. The primary end point was response based on uric acid level. Secondary end points included response to rasburicase in association with lactate dehydrogenase, serum creatinine, calcium, phosphorus, blood pH, and oncologic diagnosis. RESULTS: Median age was 65 years and 70% were men. Most patients had leukemia (32%) or lymphoma (40%). Eighty-seven of 92 patients (95%), who received single 6-mg dose of rasburicase, achieved a uric acid less than 7.5 mg/dL within 24-36h of dosing. Body mass index was similar between responders and non-responders: 28.6 kg/m2 vs. 26.6 kg/m2, respectively, p = 0.6. Baseline lactate dehydrogenase levels were similar between the groups: 756 U/L vs. 892 U/L, respectively, p = 0.33. Blood pH values documented within 24 h of first dose of rasburicase were also similar between the two groups (n = 30; 7.33 vs. 7.34 respectively, p = 0.6). However, median baseline uric acid was lower in responders than non-responders: 12.3 mg/dL vs. 17.3 mg/dL, respectively, p = 0.012. Baseline serum creatinine and creatinine clearance were similar between responders and non-responders (2.2 mg/dL vs. 3.95 mg/dL; p = 0.12 and 29 mL/min vs. 16 mL/min; p = 0.11, respectively). CONCLUSIONS: Higher baseline uric acid levels were observed in patients who did not respond to the first rasburicase dose. In our study, uric acid levels normalized in 95% of patients after a single 6-mg dose of rasburicase indicating that a single 6-mg dose of rasburicase may be sufficient to manage tumor lysis syndrome, for most patients.
Assuntos
Supressores da Gota/uso terapêutico , Síndrome de Lise Tumoral/tratamento farmacológico , Urato Oxidase/uso terapêutico , Ácido Úrico/sangue , Centros Médicos Acadêmicos , Idoso , Antineoplásicos/efeitos adversos , Índice de Massa Corporal , Cálcio/sangue , Creatinina/sangue , Feminino , Supressores da Gota/administração & dosagem , Humanos , Concentração de Íons de Hidrogênio , Hiperuricemia/sangue , L-Lactato Desidrogenase/sangue , Leucemia/tratamento farmacológico , Linfoma/tratamento farmacológico , Masculino , Fósforo/sangue , Estudos Retrospectivos , Fatores de Risco , Síndrome de Lise Tumoral/etiologia , Síndrome de Lise Tumoral/prevenção & controle , Urato Oxidase/administração & dosagemRESUMO
BACKGROUND: The American Society of Clinical Oncology guidelines recommend rasburicase for the treatment of pediatric patients with hyperuricemia at risk of tumor lysis syndrome (TLS) using a weight-based dose of 0.1-0.2 mg/kg once daily for 1-7 days. However, there has been a trend in practice due to recent data showing benefit using a fixed-dose approach. The purpose of this study was to evaluate the efficacy and safety between fixed and weight-based dosing of rasburicase in a pediatric population. PROCEDURE: This was a retrospective chart review of 48 patients from January 1, 2007 to August 31, 2016 at Children's National Health System. Patients less than 18 years old with a documented diagnosis of a malignancy and baseline uric acid level were included; patients less than 30 kg at the time of rasburicase administration were excluded. RESULTS: The primary endpoint of this study was the treatment success of normalization of uric acid level (<5 mg/dl) within 24 hr of rasburicase administration. Eighty-three percent of patients had success with normalization of uric acid post rasburicase dose. Eighty-five percent of patients had success in the weight-based group compared to eighty-one percent in the fixed-dose group (P = 0.715). Mean percent reduction of uric acid at 24 hr was relatively similar between both groups (94% vs. 89%). CONCLUSION: Our results suggest that a fixed-dose strategy of rasburicase is both safe and effective in reducing uric acid levels in the pediatric patient population. A fixed dose of rasburicase 6 mg is a cost-effective treatment option for TLS.
Assuntos
Supressores da Gota/administração & dosagem , Hiperuricemia/tratamento farmacológico , Síndrome de Lise Tumoral/tratamento farmacológico , Urato Oxidase/administração & dosagem , Adolescente , Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Feminino , Supressores da Gota/efeitos adversos , Supressores da Gota/economia , Humanos , Hiperuricemia/etiologia , Masculino , Neoplasias/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento , Síndrome de Lise Tumoral/etiologia , Urato Oxidase/efeitos adversos , Urato Oxidase/economiaRESUMO
BACKGROUND: The combination of everolimus and the imidazoquinoline derivative, BEZ235 (dactolisib), a dual PI3K/mTOR inhibitor, demonstrated synergy in a preclinical model. OBJECTIVE: To establish clinical feasibility, a phase Ib dose-escalation trial investigating safety and pharmacokinetics of this combination in patients with advanced tumors was performed. PATIENTS AND METHODS: BEZ235 was orally administered daily in escalating doses of 200, 400, and 800 mg along with everolimus at 2.5 mg daily in 28-day cycles. Nineteen patients were enrolled. Adverse events and tumor responses were evaluated using CTCAE v4.0 and RECIST 1.1, respectively. Pharmacokinetic analyses were performed. RESULTS: Common toxicities observed included fatigue, diarrhea, nausea, mucositis, and elevated liver enzymes. No confirmed responses were observed. BEZ235 pharmacokinetics exhibited dose-proportional increases in Cmax and AUC0-24 over the three doses, with high inter-individual variability. Non-compartmental and population pharmacokinetic-based simulations indicated significant increases in everolimus Cmax and AUC0-24 on day 28 and decreased clearance to 13.41 L/hr. CONCLUSIONS: The combination of BEZ235 and everolimus demonstrated limited efficacy and tolerance. BEZ235 systemic exposure increased in a dose-proportional manner while oral bioavailability was quite low, which may be related to gastrointestinal-specific toxicity. The changes in steady-state pharmacokinetics of everolimus with BEZ235 highlight potential drug-drug interactions when these two drugs are administered together. Clinicaltrials.gov: NCT01508104.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Everolimo/uso terapêutico , Imidazóis/uso terapêutico , Neoplasias/tratamento farmacológico , Quinolinas/uso terapêutico , Administração Oral , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Avaliação Pré-Clínica de Medicamentos , Sinergismo Farmacológico , Everolimo/efeitos adversos , Feminino , Humanos , Imidazóis/efeitos adversos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/patologia , Fosfatidilinositol 3-Quinases/metabolismo , Quinolinas/efeitos adversos , Serina-Treonina Quinases TOR/metabolismo , Síndrome de Lise Tumoral/etiologiaRESUMO
Acute tumor lysis syndrome results from a sudden and rapid release of products of cellular breakdown after anticancer therapy. Severe alterations of metabolic profile might occur and result in acute renal failure. We present a patient with a large hepatocellular carcinoma who received transcatheter oily chemoembolization and died subsequently of this syndrome. To our knowledge, there has been only one report of this syndrome induced by chemoembolization for hepatocellular carcinoma. This case illustrates the need to anticipate the development of acute tumor lysis syndrome when chemoembolization is planned for a large hepatocellular carcinoma.
Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Meios de Contraste , Epirubicina/efeitos adversos , Óleo Iodado , Neoplasias Hepáticas/terapia , Síndrome de Lise Tumoral/etiologia , Angiografia , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Relação Dose-Resposta a Droga , Evolução Fatal , Esponja de Gelatina Absorvível , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Retratamento , Tomografia Computadorizada Espiral , Síndrome de Lise Tumoral/diagnóstico por imagemRESUMO
The manifestation of tumor lysis syndrome (TLS) occurs when the destruction of tumor cells releases breakdown products that overwhelm the excretory mechanisms of the body. A cardinal sign is hyperuricemia, leading to uric acid nephropathy. Other signs are hyperkalemia, hyperphosphatemia and secondary hypocalcemia. Conventional management of TLS consists of aggressive intravenous hydration, diuretic therapy, urinary alkalization, and inhibition of urate production by high-dose allopurinol. Urate oxidase has been used in the management of patients at risk for TLS and recently the recombinant urate oxidase rasburicase was developed. Several data indicate that rasburicase is effective and well tolerated in the prevention and treatment of chemotherapy-induced hyperuricemia. Treatment options of hyperkalemia include sodium polystyrene sulfonate, hypertonic glucose and insulin, loop diuretics, and bicarbonate. Treatment of hyperphosphatemia reduces dietary phosphate intake and includes phosphate binders such as aluminum hydroxide and aluminum carbonate. When recurrent hypocalcemia is present, a continuous intravenous infusion of calcium gluconate can be initiated. Hemodialysis should be considered for every patient with excessively elevated uric acid, phosphate and/or potassium and in those patients with acute renal failure to control urinary volume and manage uremia.
Assuntos
Síndrome de Lise Tumoral/etiologia , Síndrome de Lise Tumoral/terapia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Antineoplásicos/efeitos adversos , Humanos , Hiperpotassemia/etiologia , Hiperpotassemia/terapia , Hiperuricemia/etiologia , Hiperuricemia/terapia , Hipocalcemia/etiologia , Hipocalcemia/terapia , Neoplasias/tratamento farmacológico , Síndrome de Lise Tumoral/complicações , Síndrome de Lise Tumoral/metabolismoRESUMO
Tumor lysis syndrome (TLS) is an important complication associated with hematological malignancies leading to increased morbidity and mortality. Metastatic calcification due to calcium phosphate crystals precipitated in soft tissues is rarely encountered in TLS. We describe a child with non-Hodgkin lymphoma who had gastric mucosal calcification related to severe hyperphosphatemia due to TLS. Upper-gastrointestinal endoscopic examination performed because of abdominal complaints revealed diffuse mucosal white lesions in mucosa of the gastric antrum and corpus. Pathological examination of the mucosa of the gastric corpus showed marked calcification in the lamina propria. We suggest that calcification in mucosa of the gastric corpus may be seen in patients with TLS. We also suggest that gastric mucosal calcifications should be considered in patients with hematological malignancies from TLS.
Assuntos
Calcinose/etiologia , Mucosa Gástrica/patologia , Linfoma não Hodgkin/complicações , Síndrome de Lise Tumoral/etiologia , Calcinose/diagnóstico , Criança , Endoscopia Gastrointestinal , Feminino , Humanos , Fósforo/sangue , Síndrome de Lise Tumoral/diagnósticoRESUMO
In this multicenter, nonrandomized, open-label clinical trial conducted from July 2003 to July 2004, recombinant urate oxidase (rasburicase) was administered to patients at risk for tumor lysis syndrome before or during the initiation of chemotherapy. Forty-five patients were enrolled, including 18 children (10 with acute lymphoblastic leukemia, 6 with high-grade lymphoma, and 2 with acute myeloid leukemia) and 27 adults (8 with acute lymphoblastic leukemia, 4 with high-grade lymphoma, 9 with multiple myeloma, and 6 with acute myeloid leukemia). The age ranged from 3 to 98 years, with a median age of 7 years in children and 59.3 years in adults. There were 14 males and 4 females in the pediatric group and 18 males and 9 females in the adult group. Rasburicase 0.2 mg/kg was administered intravenously once a day for 2-6 days, for a median of 3 days in children and of 4 days in adults. After 3 days of treatment, the median uric acid levels in the 18 children decreased from 10.5 mg/dl (range 8-18.6) to 0.5 mg/dl (range 0.0-1.7). Similarly, in the 27 adults, the median levels decreased from 10.8 mg/dl (range 8-24.4) to 0.5 mg/dl (range 0.0-1.6). No significant changes were observed in serum potassium, calcium, and phosphorus concentrations. None of the patients required dialysis for acute renal failure. Rasburicase was very well tolerated, with only 1 adult having grade 1 vomiting. We conclude that rasburicase is safe and highly effective for preventing the complications of tumor lysis syndrome in patients with hematologic malignancies.
Assuntos
Neoplasias Hematológicas , Leucemia , Linfoma não Hodgkin , Síndrome de Lise Tumoral/prevenção & controle , Urato Oxidase/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/sangue , Criança , Pré-Escolar , Feminino , Neoplasias Hematológicas/sangue , Neoplasias Hematológicas/complicações , Humanos , Injeções Intravenosas , Leucemia/sangue , Leucemia/complicações , Linfoma não Hodgkin/sangue , Linfoma não Hodgkin/complicações , Masculino , Pessoa de Meia-Idade , Fósforo/sangue , Potássio/sangue , Fatores de Risco , Síndrome de Lise Tumoral/sangue , Síndrome de Lise Tumoral/etiologia , Ácido Úrico/sangueRESUMO
Adenosine deaminase inhibitors have proven superior to alkylating agent-based therapies in inducing clinical and hematologic remissions in treated and previously untreated chronic lymphocytic leukemia (CLL) patients, and they have become increasingly accepted as a standard for therapy. We report the case of a 66-year-old patient with a 7-year history of CLL who had been previously treated with alkylating agents. Upon presentation with abdominal lymphadenopathy, a 5-day course of the nucleoside analogue, fludarabine, was administered. Two days after completion, the patient developed acute tumor lysis syndrome (TLS) that induced renal failure with hyperkalemia and hyperuricemia. This resulted in critical, life-threatening complications requiring hospitalization, aggressive hemodialysis and fluid replacement therapy. While only 5 other cases of TLS associated with fludarabine therapy have been reported since 1989, we recommend that adenosine deaminase inhibitor therapy be initiated with the addition of allopurinol, and that hydration with copious amounts of oral fluids during therapy be encouraged in order to help protect against the renal effects of potential TLS induced by these agents.
Assuntos
Antineoplásicos/efeitos adversos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Síndrome de Lise Tumoral/etiologia , Vidarabina/análogos & derivados , Vidarabina/efeitos adversos , Idoso , Nitrogênio da Ureia Sanguínea , Cálcio/sangue , Creatinina/sangue , Evolução Fatal , Hidratação , Humanos , Masculino , Fósforo/sangue , Potássio/sangue , Diálise Renal , Síndrome de Lise Tumoral/diagnóstico , Síndrome de Lise Tumoral/terapia , Ácido Úrico/sangueRESUMO
BACKGROUND: Lipiodolized chemoembolization of hepatocellular carcinoma (HCC) can induce fever and cytolysis, defined as an increase in serum levels of liver transaminases, which is frequently assumed to result from tumour necrosis. This study aimed to assess the causes of this syndrome, reviewing preoperative data, intraoperative findings, tumour necrosis and the status of non-tumorous liver. METHODS: A retrospective study was undertaken of 29 patients treated by neoadjuvant lipiodolized chemoembolization before surgical resection of HCC. Tumour necrosis was assessed in the resected specimen and scored in four stages: absent, 50 per cent or less, more than 50 per cent, and complete. The status of non-tumorous liver parenchyma was classified as either fibrotic or cirrhotic. RESULTS: Cytolysis occurred following chemoembolization in 16 patients and was associated with fever in 11. Postchemoembolization cytolysis with or without fever was more likely to develop in patients with minor fibrotic changes than in those with cirrhosis (14 of 21 with fibrosis versus two of four with cirrhosis, P < 0.05). In contrast, the extent of tumour necrosis did not correlate with the occurrence of symptoms. CONCLUSION: These results suggest that fever and cytolysis following chemoembolization of HCC are an indication not of tumour necrosis but of injury to the non-tumorous liver.
Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Óleo Iodado/administração & dosagem , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/métodos , Febre/etiologia , Humanos , Cirrose Hepática/patologia , Neoplasias Hepáticas/patologia , Pessoa de Meia-Idade , Necrose , Estudos Retrospectivos , Resultado do Tratamento , Síndrome de Lise Tumoral/etiologiaRESUMO
BACKGROUND: Treatment of solid tumors rarely has been associated with tumor lysis syndrome. However, to the authors' knowledge the clinical scenario has not been reported previously in melanoma patients. METHODS: A patient with bulky metastatic melanoma was treated with concurrent biochemotherapy using interleukin-2, interferon-alpha, and a combination of cisplatin, vinblastine, and dacarbazine. RESULTS: Within 24 hours of the initiation of treatment, brisk tumor lysis occurred and led to a fatal outcome. CONCLUSIONS: Improvements in the treatment of solid tumors may increase the incidence of tumor lysis syndrome for tumors once believed to be marginally responsive. Oncologists should remain cognizant of this problem as more active regimens become available.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Síndrome de Lise Tumoral/etiologia , Doença Aguda , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Aspartato Aminotransferases/sangue , Cálcio/sangue , Cisplatino/efeitos adversos , Creatinina/sangue , Dacarbazina/efeitos adversos , Evolução Fatal , Humanos , Interferon-alfa/efeitos adversos , Interleucina-2/efeitos adversos , L-Lactato Desidrogenase/sangue , Masculino , Melanoma/sangue , Pessoa de Meia-Idade , Fósforo/sangue , Neoplasias Cutâneas/sangue , Síndrome de Lise Tumoral/sangue , Ácido Úrico/sangue , Vimblastina/efeitos adversosRESUMO
We report a patient with centroblastic non-Hodgkin's MALT lymphoma of the stomach treated initially with surgery and post-operative chemotherapy and radiotherapy. First relapse was treated with high-dose BEAM chemotherapy and autologous peripheral blood stem cell transplantation (PBSCT). Second, systemic relapse was treated with high-dose BU/CY and second PBSCT. Today, the patient is in complete remission at 27+ months. The case indicates a curative potential for high-dose BU/CY chemotherapy as salvage therapy for relapsed high-grade lymphoma after BEAM and autologous PBSCT. This may have implications for the prevention as well as for the management of lymphoma relapse after high-dose chemotherapy (HDC) and autologous PBSCT.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Linfoma de Zona Marginal Tipo Células B/terapia , Neoplasias Gástricas/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carmustina/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Doxorrubicina/administração & dosagem , Epirubicina/administração & dosagem , Etoposídeo/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Ifosfamida/administração & dosagem , Injeções Espinhais , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Linfoma de Zona Marginal Tipo Células B/radioterapia , Linfoma de Zona Marginal Tipo Células B/cirurgia , Masculino , Melfalan/administração & dosagem , Metotrexato/administração & dosagem , Prednisona/administração & dosagem , Recidiva , Indução de Remissão , Retratamento , Terapia de Salvação , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/radioterapia , Neoplasias Gástricas/cirurgia , Condicionamento Pré-Transplante , Síndrome de Lise Tumoral/etiologia , Vincristina/administração & dosagemRESUMO
Hyperuricemia is a common manifestation in various hematological disorders such as hemolytic anemias, megaloblastic anemia malignant lymphomas and leukemias. Tumor lysis syndrome (TLS) is a serious complication consists of hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia due to massive cell lysis, which occurs shortly after the onset of chemotherapy or radiotherapy for acute leukemias and malignant lymphomas. Acute renal failure may develop due to uric acid nephropathy. The risk factors of TLS are heavy tumor cell burden, rapid cell turn over rate and renal involvement of neoplastic cells. To prevent and control TLS, adequate intravenous hydration to keep patient's urine volume, alkalization of urine by sodium bicarbonate and inhibition of uric acid production by high dose allopurinol is recommended.
Assuntos
Doenças Hematológicas/complicações , Síndrome de Lise Tumoral/etiologia , Ácido Úrico/sangue , Medula Óssea/patologia , Doenças da Medula Óssea/etiologia , Humanos , Nefropatias/etiologia , NecroseRESUMO
We report on a 14-year-old boy with acute lymphoblastic leukemia (lymphoma-leukemia) who had two episodes of acute tumor lysis syndrome during induction of remission with oral prednisolone alone and oral prednisolone, intravenous vincristine, and doxorubicin, respectively. Subsequently he had severe hyperphosphatemia (29.3 and 14.1 mg/dl; 9.46 and 4.55 mmol/L), hypocalcemia, hyperuricemia, hyperkalemia, and azotemia. Multiple stones and tumor cells infiltration were demonstrated in both kidney. He responded favorably to hemodialysis.
Assuntos
Leucemia Linfoide/tratamento farmacológico , Fósforo/sangue , Síndrome de Lise Tumoral/complicações , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Pré-Escolar , Humanos , Cálculos Renais/etiologia , Cálculos Renais/terapia , Masculino , Diálise Renal , Síndrome de Lise Tumoral/etiologiaRESUMO
We report a 4-year-old boy who developed tumor lysis syndrome complicated by severe hyperphosphatemia and acute renal failure, following chemotherapy for T-cell acute lymphoblastic leukemia. Despite successful treatment of hyperphosphatemia with hemodialysis, there was an immediate rebound in the high serum phosphorus level. The patient underwent a second treatment with hemodialysis which was then followed by continuous veno-venous hemofiltration (CVVH). CVVH maintained his serum phosphorus at a stable level until his renal function improved. CVVH can be used in conjunction with hemodialysis to successfully treat the hyperphosphatemia associated with tumor lysis syndrome.