scholarly journals P0568INCIDENCE AND RISK FACTORS OF ACUTE KIDNEY INJURY AND TUMOR LYSIS SYNDROME IN PATIENTS WITH MULTIPLE MYELOMA TREATED WITH BORTEZOMIB

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
SEUNGMIN SONG ◽  
Hyo jin Boo ◽  
Hye Ryoun Jang ◽  
Wooseong Huh ◽  
Dae Joong Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Multivariate Analyses ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Renal Amyloidosis ◽  
Tumor Lysis ◽  
Β2 Microglobulin

Abstract Background and Aims Nephrotoxicity of bortezomib, a proteasome inhibitor, has not yet been described frequently, while tumor lysis syndrome (TLS) associated with multiple myeloma (MM) has been increased after introduction of the drug. This study compared the incidence and risk factors of acute kidney injury (AKI) and TLS in patients with MM after bortezomib-based chemotherapy to investigate the drug-related nephrotoxicity. Method From 2006 to 2017, 276 patients who underwent first cycle of bortezomib-based chemotherapy for MM were identified in single tertiary hospital. Laboratory TLS was defined according to the Cairo-Bishop definition. Development of AKI was assessed by AKI Network (AKIN) criteria within 7 days after first chemotherapy. Results The age was 65 [56-72] years old, and 47% (n=131) of participants were female and baseline estimated glomerular filtration rate (eGFR) was 61.3 [34.1-89.1] mL/min/1.73m2. The incidences of AKI and laboratory TLS were 17% (n=47) and 13% (n=36), respectively. Ten (3.6%) subjects corresponded to the both AKI and TLS criteria. Multivariate analyses showed that lower eGFR category (30∼59, odds ratio [OR]=3.063 [1.278-7.339]; 15∼29, OR=3.417 [1.088-10.726]; <15, OR=10.080 [2.677-37.951] vs ≥ 60), lower serum albumin level (OR=0.491 [0.278-0.868], P=0.0144) and renal amyloidosis (OR=11.174 [3.974-31.420], P<0.0001) were predictors of development of AKI. MM stages and β2-microglobulin were not associated with AKI occurrence. Regarding laboratory TLS, MM stage and β2-microglobulin were higher in those with TLS. In multivariate analyses, β2-microglobulin levels (OR=1.194 [1.066-1.337], P=0.0021) and any chromosomes abnormalities at high risk (OR=0.115 [0.026-0.503], P=0.0041) were associated with higher risk of TLS. Conclusion Development of AKI was often observed without being accompanied by TLS in patients with MM after treatment of bortezomib. In addition, risk factors of AKI and TLS were widely different. These findings implicated the potential nephrotoxicity of bortezomib besides TLS in patients with decreased kidney function. The efforts to prevent bortezomib associated AKI are needed in patients at high risk.

scholarly journals Spontaneous Tumour Lysis Syndrome in a Multiple Myeloma

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Can Huzmeli ◽  
Eylem Eliacik ◽  
Mustafa Saglam ◽  
Baris Doner ◽  
Ferhan Candan
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Metabolic Acidosis ◽  
Tumor Lysis Syndrome ◽  
Laboratory Data ◽  
Compression Fracture ◽  
Kidney Injury ◽  
Metabolic Abnormalities ◽  
Tumor Lysis

The tumor lysis syndrome (TLS) is a collection of metabolic abnormalities that occur in consequence of the release of intracellular contents following lysis of tumor cells. TLS occurs spontaneously or after chemotherapy. Spontaneous TLS is uncommon occurrence in multiple myeloma (MM). We define a case of a 70-year-old woman patient who was found to have MM with spontaneous TLS, following a compression fracture of the T-12 vertebrae. While serum uric acid and phosphorous levels were high, low calcium levels were identified. There were also acute kidney injury and metabolic acidosis. Upon the diagnosis of TLS, she was treated with hydration, allopurinol, sodium bicarbonate, and calcium gluconate. The improvement of her laboratory data was observed. We submitted this case in order to draw attention to the presentation of MM with spontaneous TLS.

Rational use of rasburicase for the treatment and management of tumor lysis syndrome

2017 ◽  
Vol 24 (3) ◽  
pp. 176-184 ◽  
Author(s):  
Suhail A Shaikh ◽  
Bernard L Marini ◽  
Shannon M Hough ◽  
Anthony J Perissinotti
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
High Risk ◽  
Uric Acid Level ◽  
Acid Level ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
P Value ◽  
Tumor Lysis ◽  
Conservative Group

Purpose There is a lack of high-level evidence identifying meaningful outcomes and the optimal place in therapy of rasburicase in patients with, or at high risk for tumor lysis syndrome. The primary objective of this study was to evaluate and characterize outcomes resulting from an institution-specific guideline emphasizing supportive care, xanthine oxidase inhibitors, and lower doses of rasburicase. Methods In this retrospective chart review, we compared conservative rasburicase dosing, in accordance with newly developed UMHS tumor lysis syndrome guidelines, with aggressive rasburicase in adult patients (≥ 18 years of age) with hematological or solid tumor malignancies, and a uric acid level between 8 and 15 mg/dL. The primary efficacy outcome assessed the difference in the proportion of patients achieving a uric acid level <8 mg/dL within 48 h using a one-sided noninferiority test. The principle safety outcomes analyzed included incidence of acute kidney injury and hemodialysis requirement. Results One hundred sixty-one patients met inclusion criteria and were included in the study. Within 48 h of an elevated uric acid level, treatment was successful in 97.03% of patients in the conservative group, as compared with 98.33% in the aggressive group (difference, 1.3 percentage points; 95% confidence interval [CI], −3.33 to 5.93). Furthermore, there was no difference in the proportion of patients requiring hemodialysis (2.97% vs. 10.0%, p-value 0.079), or incidence of acute kidney injury (4.0% vs. 12.5%, p-value 1.00) between the treatment group and control group, respectively. Conclusions Conservative rasburicase use was noninferior to aggressive rasburicase use in patients with or at high risk for tumor lysis syndrome.

scholarly journals Acute Kidney Injury in Hematopoietic Stem Cell Transplantation: A Review

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Vinod Krishnappa ◽  
Mohit Gupta ◽  
Gurusidda Manu ◽  
Shivani Kwatra ◽  
Osei-Tutu Owusu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Hematopoietic Stem ◽  
Tumor Lysis ◽  
Marrow Infusion

Hematopoietic stem cell transplantation (HSCT) is a highly effective treatment strategy for lymphoproliferative disorders and bone marrow failure states including aplastic anemia and thalassemia. However, its use has been limited by the increased treatment related complications, including acute kidney injury (AKI) with an incidence ranging from 20% to 73%. AKI after HSCT has been associated with an increased risk of mortality. The incidence of AKI reported in recipients of myeloablative allogeneic transplant is considerably higher in comparison to other subclasses mainly due to use of cyclosporine and development of graft-versus-host disease (GVHD) in allogeneic groups. Acute GVHD is by itself a major independent risk factor for the development of AKI in HSCT recipients. The other major risk factors are sepsis, nephrotoxic medications (amphotericin B, acyclovir, aminoglycosides, and cyclosporine), hepatic sinusoidal obstruction syndrome (SOS), thrombotic microangiopathy (TMA), marrow infusion toxicity, and tumor lysis syndrome. The mainstay of management of AKI in these patients is avoidance of risk factors contributing to AKI, including use of reduced intensity-conditioning regimen, close monitoring of nephrotoxic medications, and use of alternative antifungals for prophylaxis against infection. Also, early identification and effective management of sepsis, tumor lysis syndrome, marrow infusion toxicity, and hepatic SOS help in reducing the incidence of AKI in HSCT recipients.

KIDNEY INJURY IN CANCER THERAPY

2018 ◽  
Vol 22 (5) ◽  
pp. 17-24 ◽  
Author(s):  
E. V. Burnasheva ◽  
Y. V. Shatokhin ◽  
I. V. Snezhko ◽  
A. A. Matsuga
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Cytotoxic Effect ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Chemotherapeutic Agents ◽  
Oxygen Intermediates ◽  
Circulating Blood Volume

Кidney injury is a frequent and significant complication of cancer and cancer therapy. The kidneys are susceptible to injury from malignant infiltration, damage by metabolites of malignant cells, glomerular  injury, nephrotoxic drugs including chemotherapeutic agents. Also  bone marrow transplantation complications, infections with immune  suppression (including septicemia), tumor lysis syndrome should be  taken into account. Chemotherapeutic agents are a common cause  of acute kidney injury but can potentially lead to chronic kidney  disease development in cancer patients. This article summarizes risk  factors of acute kidney injury in cancer patients. Risk factors are  divided into two groups. The systemic are decrease of total  circulating blood volume, infiltration of kidney tissue by tumor cells,  dysproteinemia, electrolyte disturbances. The local (renal) risk  factors are microcirculation disturbances, drugs biotransformation  with formation of reactive oxygen intermediates, high concentration of nephrotoxic agents in proximal tubules and its  sensitivity to ischemia. Drug-related risk factors include: drugs  combination with cytotoxic effect high doses long term use necessity, direct cytotoxic effect of not only chemotherapeutic agents but also its metabolites, mean solubility forming intratubular  precipitates. Early diagnosis, timely prevention and treatment of  these complications provide significantly improve nononcologic results of treatment.

scholarly journals Bortezomib administration is a risk factor associated with the development of tumor lysis syndrome in male patients with multiple myeloma: A retrospective study

2020 ◽  
Author(s):  
Masahiro Kondo ◽  
Yuji Hotta ◽  
Karen Yamauchi ◽  
Akimasa Sanagawa ◽  
Hirokazu Komatsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Odds Ratio ◽  
Tumor Lysis Syndrome ◽  
Low Risk ◽  
Novel Therapies ◽  
Tumor Lysis ◽  
Factors Associated ◽  
Increased Risk ◽  
Male Patients

Abstract Background: Novel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma. Although multiple myeloma is a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. Previous studies, mostly case reports or case series, have reported bortezomib-induced TLS in patients with multiple myeloma. This study aimed to investigate risk factors associated with TLS development in multiple myeloma patients.Methods: We retrospectively investigated incidences of laboratory and clinical TLS (LTLS and CTLS, respectively) in patients who received primary therapy for treatment-naive, symptomatic multiple myeloma between May 2007 and January 2018. We used multivariate logistic regression analyses to evaluate the associations between TLS and several parameters previously reported to be associated with increased risk.Results: This study included 210 patients with multiple myeloma, of which ten (4.8%) had LTLS and seven (3.3%) had CTLS. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between patients with and without TLS. Multivariate analyses revealed that TLS was most strongly associated with bortezomib-containing therapy (odds ratio = 3.40, P = 0.069), followed by male sex (odds ratio = 2.29, P = 0.153). In a subgroup analysis focused on men, treatment with bortezomib-containing therapy was significantly associated with increased risk of TLS (odds ratio = 8.51, P = 0.046).Conclusion: In the present study, we investigated the risk factors associated with TLS development in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date. Furthermore, this study is the first to evaluate TLS risk factors in MM by adjusting for the effects of potential confounding factors in patients’ backgrounds. Consequently, we found that bortezomib-containing therapy increases the risk of TLS in male patients with multiple myeloma. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, since a significant number of novel therapies can achieve high antitumor responses.

scholarly journals Risk factors for acute kidney injury among patients with rhabdomyolysis

2020 ◽  
Author(s):  
Jia Yang ◽  
Jiaojiao Zhou ◽  
Xin Wang ◽  
Siwen Wang ◽  
Yi Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Hospital Mortality ◽  
Laboratory Data ◽  
Elevated Serum ◽  
Kidney Injury ◽  
Chronic Alcoholism ◽  
Multiple Organ ◽  
Bee Sting

Abstract Background Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of AKI defined by the Kidney Disease Improving Global Outcomes criteria and in-hospital mortality. Methods We performed a retrospective study of patients with creatine kinase levels >1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted. Results For the 329 patients included in our study, the incidence of AKI was 61.4%, and the overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P<0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to AKI. The risk factors for the occurrence of AKI among RM patients included age ≥60 years (OR=3.070), chronic alcoholism (OR=3.256), hypertension (OR=4.252), multiple organ dysfunction syndrome (MODS; OR=7.244), high levels of white blood cell count (OR=1.047) and elevated serum phosphorus (OR=5.526). Age ≥60 years (OR=3.188), MODS (OR=2.262), diabetes (OR=2.746) and elevated prothrombin time (OR=1.079) were independent risk factors for in-hospital mortality in RM patients with AKI. Conclusions AKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.

scholarly journals Tumor Lysis Syndrome Management in Community Oncology Settings

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5875-5875
Author(s):  
Scott Howard
Keyword(s):  
Acute Kidney Injury ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Research Network ◽  
Newly Diagnosed ◽  
Bulky Disease ◽  
Tumor Lysis ◽  
Lowering Therapy ◽  
Community Oncology ◽  
The Guardian

Background Tumor lysis syndrome (TLS) can complicate the management of patients with bulky chemosensitive cancers. TLS incidence and severity are increasing with new highly effective agents for hematologic cancers. However, prophylaxis and management vary widely, even within the same center. Methods We examined TLS management and outcomes from records of 14383 newly-diagnosed adults with lymphoma treated from 2010- 2019 at 110 member hospitals of the Guardian Research Network (GRN, www.GuardianResearch.org), a non-profit community oncology consortium with a database containing patients' entire medical, including all demographics, diagnoses, labs, medications, procedures, encounters, and notes of all kinds (clinical, radiology reports). Anonymized, de-identified data about demographics, diagnosis, treatment, supportive care, and outcomes was analyzed to determine patterns of TLS management in the community setting. Natural language processing was used to identify clinicians' references to tumor lysis syndrome, risk assessment, and cancer bulk. Results Of 529784 cancer patients in the Guardian Research Network database, there were 14383 newly-diagnosed adults with lymphoma, of whom 81% received no uric acid lowering therapy, 17% received allopurinol or febuxostat, and only 2% received Rasburicase. TLS management varied by region: 11% of patients in Virginia received uric acid lowering therapy vs 26% in South Carolina (p<0.001) and lymphoma subtype: 11% Hodgkin lymphoma, 26% B-cell non-Hodgkin lymphomas, p<0.001). Acute kidney injury (AKI) occurred in 4.3% of patients and logistic regression confirmed NHL (versus Hodgkin), black race (versus white), and older age as risk factors (p<0.01 for each). 216 patients (1.5%) died within 30 days. Of special note, bone marrow infiltration in acute leukemia patients was not noted as a site of bulky disease, despite the fact that a marrow with 50% infiltration of leukemic cells typically contains 700 grams of cancer, and represents bulky disease that places the patient at significant risk for TLS if treated with highly active agents. Conclusions Early acute kidney injury is common in patients with B-cell lymphomas. Assessment of TLS risk and prophylaxis is warranted, especially when using new, highly effective chemotherapy agents in patients with bulky disease. Assessment of tumor bulk was rarely documented in the medical records. Table Disclosures Howard: BTG: Consultancy, Research Funding; EUSA Pharma: Consultancy; Sanofi: Consultancy, Speakers Bureau; Servier: Consultancy, Speakers Bureau; Amgen: Honoraria.

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