scholarly journals Tumor Lysis Syndrome in Patients with Hematological Malignancies

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Yohannes Belay ◽  
Ketsela Yirdaw ◽  
Bamlaku Enawgaw
Keyword(s):  
At Risk ◽  
Hematological Malignancies ◽  
Treatment Options ◽  
Tumor Lysis Syndrome ◽  
Cochrane Library ◽  
Risk Level ◽  
Tumor Lysis ◽  
Metabolic Complication ◽  
Prevention And Treatment ◽  
Patients At Risk

Tumor lysis syndrome is a metabolic complication that may follow the initiation of cancer therapy. It commonly occurs in hematological malignant patients particularly non-Hodgkin’s lymphoma and acute leukemia due to chemotherapy or spontaneously. It is characterized by a biochemical abnormality such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia and its clinical outcome is directly related to these biochemical abnormalities. Prevention and treatment of tumor lysis syndrome depend on immediate recognition of patients at risk. Therefore, identifying patients at risk and prophylactic measures are important to minimize the clinical consequences of tumor lysis syndrome. Patients with low risk should receive hydration and allopurinol. On the other hand patients with high risk should receive hydration and rasburicase in an inpatient setting. It is important to start therapy immediately, to correct all parameters before cancer treatment, to assess risk level of patients for TLS, and to select treatment options based on the risk level. In this review a comprehensive search of literatures was performed using MEDLINE/PubMed, Hinari, the Cochrane library, and Google Scholar to summarize diagnostic criteria, incidence, predicting factors, prevention, and treatment options for tumor lysis syndrome in patients with hematological malignancies.

Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome: An Evidence-Based Review

2008 ◽  
Vol 26 (16) ◽  
pp. 2767-2778 ◽  
Author(s):  
Bertrand Coiffier ◽  
Arnold Altman ◽  
Ching-Hon Pui ◽  
Anas Younes ◽  
Mitchell S. Cairo
Keyword(s):  
At Risk ◽  
High Risk ◽  
Tumor Lysis Syndrome ◽  
The United States ◽  
Standards Of Care ◽  
Close Monitoring ◽  
Tumor Lysis ◽  
High Risk Patients ◽  
Patients At Risk ◽  
Risk Patients

PurposeTumor lysis syndrome (TLS) has recently been subclassified into either laboratory TLS or clinical TLS, and a grading system has been established. Standardized guidelines, however, are needed to aid in the stratification of patients according to risk and to establish prophylaxis and treatment recommendations for patients at risk or with established TLS.MethodsA panel of experts in pediatric and adult hematologic malignancies and TLS was assembled to develop recommendations and guidelines for TLS based on clinical evidence and standards of care. A review of relevant literature was also used.ResultsNew guidelines are presented regarding the prevention and management of patients at risk of developing TLS. The best management of TLS is prevention. Prevention strategies include hydration and prophylactic rasburicase in high-risk patients, hydration plus allopurinol or rasburicase for intermediate-risk patients, and close monitoring for low-risk patients. Primary management of established TLS involves similar recommendations, with the addition of aggressive hydration and diuresis, plus allopurinol or rasburicase for hyperuricemia. Alkalinization is not recommended. Although guidelines for rasburicase use in adults are provided, this agent is currently only approved for use in pediatric patients in the United States.ConclusionThe potential severity of complications resulting from TLS requires measures for prevention in high-risk patients and prompts treatment in the event that symptoms arise. Recognition of risk factors, monitoring of at-risk patients, and appropriate interventions are the key to preventing or managing TLS. These guidelines should assist in the prevention of TLS and improve the management of patients with established TLS.

scholarly journals Controlling serum uric acid using febuxostat in cancer patients at risk of tumor lysis syndrome

2014 ◽  
Vol 8 (4) ◽  
pp. 1523-1527 ◽  
Author(s):  
MIHOKO TAKAI ◽  
TAKAHIRO YAMAUCHI ◽  
KEI FUJITA ◽  
SHIN LEE ◽  
MIYUKI OOKURA ◽  
...  
Keyword(s):  
At Risk ◽  
Uric Acid ◽  
Cancer Patients ◽  
Serum Uric Acid ◽  
Tumor Lysis Syndrome ◽  
Tumor Lysis ◽  
Patients At Risk

Abbreviated Rasburicase Dosing for the Prevention and Treatment of Hyperuricemia in Adults at Risk for Tumor Lysis Syndrome

2006 ◽  
Vol 3 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Viet Q. Ho ◽  
Gene A. Wetzstein ◽  
Stephen G. Patterson ◽  
Robert Bradbury
Keyword(s):  
At Risk ◽  
Tumor Lysis Syndrome ◽  
Tumor Lysis ◽  
Prevention And Treatment

Superiority of Rasburicase Versus Allopurinol on Serum Uric Acid Control in Adult Patients with Hematological Malignancies at Risk of Developing Tumor Lysis Syndrome : Results of a Randomized Comparative Phase III Study.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 919-919 ◽  
Author(s):  
Jorge Cortes ◽  
Karen Seiter ◽  
Richard Thomas Maziarz ◽  
Meir Wetzler ◽  
Michael Craig ◽  
...  
Keyword(s):  
At Risk ◽  
Uric Acid ◽  
Adverse Events ◽  
Serum Uric Acid ◽  
Hematological Malignancies ◽  
Tumor Lysis Syndrome ◽  
Urate Oxidase ◽  
Phase Iii ◽  
Tumor Lysis ◽  
Phase Iii Study

Abstract Tumor lysis syndrome (TLS) is a potentially lethal metabolic complication of chemotherapy or cytolytic antibody therapy usually seen in patients with hematologic malignancies, especially those malignancies with a high proliferative rate, large cellular burden and/or sensitivity to chemotherapy. The prevention and management of TLS includes hydration and reduction of serum uric acid (SUA) levels. Although Allopurinol (ALLO) has had longstanding use for TLS prophylaxis, its efficacy in controlling SUA is limited, especially due of its lack of action on pre-existing hyperuricemia. Rasburicase (RAS), a recombinant urate oxidase, effectively reduces SUA due to conversion of UA into allantoin, a readily excretable and soluble substance. RAS has significant activity in the initial management of TLS-associated acute hyperuricemia in pediatric populations, and is currently indicated in the US for this condition in children and adolescents. A prospective, randomized, controlled phase III study was conducted in adult pts to compare the efficacy in SUA control of RAS (0.20 mg/kg/d, IV) days 1–5, versus RAS+ALLO (RAS 0.20 mg/kg/d, IV days 1–3 plus oral ALLO 300 mg/day days 3–5) versus ALLO alone (300 mg/d) days 1–5. 280 pts (275 evaluable) with hematological malignancies at high or potential risk for TLS were enrolled. 92 pts received RAS, 92 pts received RAS+ALLO, and 91 received ALLO. Treatment arms were well balanced in terms of demographics, baseline characteristics, TLS risk, and percentage of pts with baseline hyperuricemia. The SUA response rate - defined as normalization of SUA (≤ 7.5mg/dl) at days 3–7 was 87.0% in the RAS arm, 78.3% in the RAS+ALLO arm and 65.9% in the ALLO arm. RAS was superior over ALLO (p=0.0009) in the overall study population as well as in pts at high risk TLS (89.0% vs. 62.8%, p=0.0012), and in pts with baseline hyperuricemia (89.5% vs. 52.9%, p=0.0151). The time to control SUA in hyperuricemic pts was 4.1 h in the RAS arm and 27 h in the ALLO arm. The mean SUA area under the curve (AUC) results indicated that there was an 8.4-fold increase in UA exposure in the ALLO arm compared to the RAS arm. There were no significant differences in the incidence or severity of adverse events, serious adverse events or deaths. The majority of RAS and/or ALLO-related adverse events were grade 1 and 2, and most of these events were hypersensitivity-related reactions. No cases of anaphylaxis, methemoglobinemia or hemolysis were observed with RAS treatment. In conclusion, RAS is superior to ALLO in normalization of SUA, with a faster effect, in adult pts at risk for TLS. RAS alone or followed by ALLO are two valid options for this patient population.

scholarly journals A randomized trial of a single-dose rasburicase versus five-daily doses in patients at risk for tumor lysis syndrome

2012 ◽  
Vol 23 (6) ◽  
pp. 1640-1645 ◽  
Author(s):  
S. Vadhan-Raj ◽  
L.E. Fayad ◽  
M.A. Fanale ◽  
B. Pro ◽  
A. Rodriguez ◽  
...  
Keyword(s):  
At Risk ◽  
Single Dose ◽  
Randomized Trial ◽  
Tumor Lysis Syndrome ◽  
Tumor Lysis ◽  
Patients At Risk

scholarly journals 1042. Stenotrophomans maltophilia Bacteremia, A 10-Year Tertiary Center Experience

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S311-S311 ◽  
Author(s):  
Ahmed Hamdi ◽  
Madiha Fida ◽  
Omar AbuSaleh ◽  
Elena Beam
Keyword(s):  
At Risk ◽  
Broad Spectrum ◽  
Treatment Options ◽  
Hemodynamic Instability ◽  
Fluoroquinolone Resistance ◽  
Common Source ◽  
High Morbidity ◽  
Tertiary Center ◽  
Risk Sources ◽  
Patients At Risk

Abstract Background Stenotrophomonas maltophilia is a hospital acquired infection that is associated with high morbidity and mortality. There has been a reported rise in S. maltophilia infections, presumed secondary to the increase in the population at risk. Methods We retrospectively reviewed all hospitalized adult patients in Mayo Clinic, MN with S. maltophilia bacteremia from January 2008 through January 2018. We analyzed patient population and described patients at risk, sources of infection, and changes in antimicrobial susceptibility profile. Results A total of 94 patients were analyzed, including 52 males, median age of 56 (46–65.75 IQR). The population included 60 infections in those with malignancies and 30 infections in transplant recipients. At presentation, 58 (61.7%) were febrile, while 54 (58.1%) presented with hemodynamic instability. Majority (70.2%) received broad-spectrum antimicrobials within 2 weeks of presentation. The most common source was catheter associated infection (n = 60), 15 cases were secondary to gastrointestinal, and 9 due to a pulmonary source. Almost half, 46 (48.9%) required ICU admission. Two patients were diagnosed with endocarditis. Most isolates, 61(64.9%), were resistant to ceftazidime, 2 (2.2%) resistant to TMP/SMX and 20 (21.5%) were resistant to levofloxacin. Exposure to a quinolone in the 30 days prior to presentation did not impact fluoroquinolone resistance. Five patients were exposed to Trimethoprim/Sulfamethoxazole (TMP/SMX) in the 30 days prior to presentation, which was associated with higher rate of TMP/SMX resistance compared with those without exposure (80% vs. 98.8%, P = 0.004). Treatment options commonly included combination therapy, and TMP/SMX was a primary agent used in the majority, 59 (62.8%). All-cause in-hospital mortality was 26.6%. All-cause mortality was lower for line associated infections (16.67%) vs. other sources (44.12%) with P = 0.0038. Conclusion S. maltophilia bacteremia should be considered in hospitalized patients with recent use of broad-spectrum antibiotics. Although TMP/SMX continues to have reliable activity, use of empiric ceftazidime pending susceptibility testing should be avoided as trend toward increasing resistance is noted. We noted a drop in TMP/SMX susceptibility in those with recent reported TMP/SMX use. Disclosures All authors: No reported disclosures.

Rare incidence of tumor lysis syndrome in metastatic prostate cancer following treatment with docetaxel

2017 ◽  
Vol 24 (2) ◽  
pp. 153-155 ◽  
Author(s):  
Sharonlin Bhardwaj ◽  
Seema Varma
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Metastatic Prostate Cancer ◽  
Hematological Malignancies ◽  
Tumor Lysis Syndrome ◽  
Clinical Manifestations ◽  
High Grade ◽  
Cell Turnover ◽  
Metabolic Disturbances ◽  
Tumor Lysis

Tumor lysis syndrome is a serious and sometimes lethal complication of cancer treatment that is comprised of a set of metabolic disturbances along with clinical manifestations. Initiating chemotherapy in bulky, rapidly proliferating tumors causes rapid cell turnover that in turn releases metabolites into circulation that give rise to metabolic derangements that can be dangerous. This syndrome is usually seen in high-grade hematological malignancies. Less commonly, tumor lysis syndrome can present in solid tumors and even rarely in genitourinary tumors. In this report, the authors describe a specific case of tumor lysis syndrome in a patient with metastatic prostate cancer following treatment with docetaxel.

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