ABSTRACT
The tumor lysis syndrome (TLS) is a life-threatening complication caused by the massive release of nucleic acids, potassium and phosphate into the blood. This complication is the result of tumor cell lysis, which may occur due to treatment of drug sensitive and is characterized by rapid capacity of proliferation, that is often hematological origin. Moreover, the TLS can be observed before starting the treatment due to spontaneous tumor cell death, and frequently worsens when chemotherapy is initiated. TLS has high mortality, so that its prevention continues to be the most important therapeutic measure. In the intensive care unit (ICU), physicians should be aware of the clinical characteristics of TLS, which results in severe electrolyte metabolism disorders, especially hyperkalemia, hyperphosphatemia and hypocalcemia, and acute kidney injury which is a major cause of ICU mortality. An adequate strategy for the management of the TLS, combining hydration, urate oxidase, and an early admission to ICU can control this complication in most patients. The aim of this review is to provide diagnostic tools that allow to the ICU physician to recognize the population at high risk for developing the TLS, and outline a proper strategy for treating and preventing this serious complication.
Subject(s)
Critical Care/methods , Tumor Lysis Syndrome/diagnosis , Tumor Lysis Syndrome/therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/prevention & control , Acute Kidney Injury/therapy , Allopurinol/therapeutic use , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/adverse effects , Arrhythmias, Cardiac/drug therapy , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/prevention & control , Chelation Therapy , Clinical Trials as Topic , Combined Modality Therapy , Fluid Therapy , Humans , Hyperkalemia/drug therapy , Hyperkalemia/etiology , Hyperphosphatemia/drug therapy , Hyperphosphatemia/etiology , Hypocalcemia/drug therapy , Hypocalcemia/etiology , Incidence , Multicenter Studies as Topic , Prognosis , Renal Replacement Therapy , Risk Factors , Severity of Illness Index , Tumor Lysis Syndrome/blood , Tumor Lysis Syndrome/epidemiology , Tumor Lysis Syndrome/prevention & control , Urate Oxidase/therapeutic useABSTRACT
The treatment of AL amyloidosis was not successful until the advent of myeloablative chemotherapy consisting of high-dose intravenous melphalan followed by autologous peripheral blood stem cell transplantation. This new treatment has achieved better survival rates and, remarkably, it has obtained complete remission. Among patients with renal involvement, achievement of a complete hematological response was associated with a 50% reduction in proteinuria and stable creatinine clearance in more than 2/3 of patients. Despite of these excellent results, this new therapy is associated with significant toxicity, including the development of acute renal failure due to white blood cell lysis syndrome. We report a 59 year-old female with a nephrotic syndrome due to primary amyloidosis successfully treated autologous stem cell transplantation who developed acute renal failure caused by white blood cell lysis syndrome. The patient required treatment with granulocytic colony stimulating factor and intermittent hemofiltration and was discharged 23 days after melphalan administration with a satisfactory renal function and white blood cell count. After one year of follow up, she maintains a good glomerular filtration rate, a proteinuria of less than, 1 g/day and normal hematological values.
Subject(s)
Amyloidosis/complications , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Melphalan/adverse effects , Myeloablative Agonists/adverse effects , Peripheral Blood Stem Cell Transplantation/adverse effects , Tumor Lysis Syndrome/etiology , Acute Kidney Injury/chemically induced , Amyloidosis/blood , Amyloidosis/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Female , Humans , Melphalan/blood , Melphalan/therapeutic use , Middle Aged , Myeloablative Agonists/therapeutic use , Transplantation, Autologous , Tumor Lysis Syndrome/blood , Tumor Lysis Syndrome/drug therapyABSTRACT
The treatment of AL amyloidosis was not successful until the advent of myeloablative chemotherapy consisting of high-dose intravenous melphalan followed by autologous peripheral blood stem cell transplantation. This new treatment has achieved better survival rates and, remarkably, it has obtained complete remission. Among patients with renal involvement, achievement of a complete hematological response was associated with a 50% reduction in proteinuria and stable creatinine clearance in more than 2/3 of patients. Despite of these excellent results, this new therapy is associated with significant toxicity, including the development of acute renal failure due to white blood cell lysis syndrome. We report a 59 year-old female with a nephrotic syndrome due to primary amyloidosis successfully treated autologous stem cell transplantation who developed acute renal failure caused by white blood cell lysis syndrome. The patient required treatment with granulocytic colony stimulating factor and intermittent hemofiltration and was discharged 23 days after melphalan administration with a satisfactory renal function and white blood cell count. After one year of follow up, she maintains a good glomerular filtration rate, a proteinuria of less than, 1 g/day and normal hematological values.