scholarly journals Role of Hypouricemic Agents in Tumor Lysis Syndrome: A Meta-Analysis

2021 ◽  
pp. 183-196
Author(s):  
Waleed Alshehri ◽  
Abdulrahman Aljohani ◽  
Reem Alhasani ◽  
Anood Alshammari ◽  
Jwael A. Alhamoud ◽  
...  
Keyword(s):  
Uric Acid ◽  
Side Effects ◽  
Meta Analysis ◽  
Tumor Lysis Syndrome ◽  
Development Rate ◽  
Tumor Lysis ◽  
Scientific Databases ◽  
Life Threatening ◽  
Adults And Children

Objective and background: Tumor lysis syndrome (TLS) is a life-threatening emergency and demands emergency care of effective outcome with minimal or no side effects. The Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate used for the management of TLS. This study was designed to evaluate the Role of Hypouricemic agents by analyzing TLS development rate, control of uric acid, and Creatinine levels. Methods: An extensive electronic data search was conducted by using all leading scientific databases. Twenty-six studies were selected to conduct this study, as per the inclusion criteria. Results: The Odd ratio of TLS development rate was 4.06, 1.24, and 1.49 by Rusbricase, Allopurinol & Febuxostate administration respectively. 95% confidence interval was reported by selected studies against TLS development rate, Uric acid, and Creatinine levels by administrating Rusbricase, Allopurinol & Febuxostate. Conclusion: All Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate, are effective to manage Tumor lysis Syndrome. However, a suitable and most effective intervention dose needs to identify with better efficacy and minimal side effects both in Adults and Children. 

scholarly journals Spontaneous Tumor Lysis Syndrome in Blastoid-Variant Mantle Cell Lymphoma: Considerations for the General Internist

2020 ◽  
Vol 8 ◽  
pp. 232470962094470 ◽  
Author(s):  
Vishal Patel ◽  
Robert Case
Keyword(s):  
Uric Acid ◽  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Tumor Lysis Syndrome ◽  
General Internist ◽  
Tumor Lysis ◽  
Spontaneous Tumor ◽  
Mantle Cell ◽  
Spontaneous Tumor Lysis Syndrome

Spontaneous tumor lysis syndrome (SPTLS) is a rare phenomenon that can manifest in rapidly proliferating hematological malignancies and solid tumors prior to initiating cytotoxic therapy. We encountered a patient who originally presented with diffuse lymphadenopathy, abdominal distention, and dyspnea, who had laboratory abnormalities suggestive of SPTLS. His peripheral flow cytometry and lymph node biopsy revealed blastoid-variant mantle cell lymphoma. Prior to initiating chemotherapy, acute kidney injury (AKI) and uric acid had improved with intravenous fluids and the initiation of allopurinol. However, after beginning chemotherapy, the patient developed a second AKI concerning for tumor lysis syndrome (TLS). He went on to have renal recovery and did not require renal replacement therapy. With the exception of case reports, there is limited evidence to guide general medicine clinicians who encounter cases of SPTLS. Expert-based guidelines are available to guide use of rasburicase, an uricase enzyme, before initiation of chemotherapy for certain malignancies when risk for TLS is considered high. Despite these guidelines, the role of rasburicase in preventing AKI remains controversial after inconclusive results in a meta-analysis. The causative relationship between uric acid and AKI in TLS is based on a mechanism of tubular obstruction. There are also mechanisms by which uric acid may cause AKI without tubular obstruction related to acute hyperuricemic nephropathy. Further characterization of the role of uric acid in causing AKI in patients without tubular obstruction may identify new mechanisms of injury and offer insight into new treatment strategies.

scholarly journals Tumor Lysis Syndrome

2018 ◽  
Vol 143 (3) ◽  
pp. 386-393 ◽  
Author(s):  
Shelly M. Williams ◽  
Anthony A. Killeen
Keyword(s):  
Tumor Lysis Syndrome ◽  
Systemic Circulation ◽  
Clinical Findings ◽  
Diagnostic Laboratory ◽  
Tumor Lysis ◽  
Circulation Characteristic ◽  
Prophylactic Measures ◽  
Life Threatening ◽  
Intravenous Hydration ◽  
Adults And Children

Tumor lysis syndrome (TLS) is an acute, life-threatening disease among adults and children that is associated with the initiation of cytoreductive therapy in the treatment of malignancy. A pattern of metabolic derangements occurs as a result of a massive release of intracellular contents into the systemic circulation. Characteristic findings include hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia, and uremia, all of which can lead to cardiac arrhythmia, seizures, renal failure, and sudden death. The incidence of TLS appears to be increasing because of a rapidly growing armamentarium of highly effective biologic and targeted therapies. Risk assessment and prevention are at the forefront of management and rely on clinician awareness, prophylactic measures, and vigilant laboratory monitoring. Established TLS requires early, aggressive intervention with intravenous hydration, electrolyte management, and the use of hypouricemic agents. This review highlights the central role of diagnostic laboratory criteria for TLS, and summarizes the clinical findings, pathophysiology, and evidence-based guidelines for the prevention and management of TLS.

scholarly journals Prevention, diagnosis and treatment of tumor lysis syndrome

2021 ◽  
Vol 11 (9) ◽  
pp. 215-222
Author(s):  
Michał Piwoński ◽  
Klaudia Żak ◽  
Sylwiusz Niedobylski ◽  
Paweł Stanicki
Keyword(s):  
Uric Acid ◽  
Kidney Failure ◽  
Cardiac Arrhythmias ◽  
Tumor Lysis Syndrome ◽  
Potassium Ions ◽  
Antitumor Therapy ◽  
Acid Phosphate ◽  
Tumor Lysis ◽  
Threatening Condition ◽  
Life Threatening

Tumor lysis syndrome (TLS) is an acute, life-threatening condition that occurs either spontaneously or as a complication of cytoreductive antitumor therapy, and occurs in both children and adults. As a result of TLS, intracellular components are released into the extracellular space, leading to dysregulation of the body's homeostasis due to the accumulation of uric acid, phosphate and potassium ions, and hypocalcemia, which may lead to cardiac arrhythmias, convulsions, or kidney failure.

scholarly journals The Domino Effect-Treatment of Superior Vena Cava Obstruction Triggering Tumor Lysis Syndrome: A Case Report

2021 ◽  
Vol 3 (1) ◽  
pp. 44-50
Author(s):  
Suman Ghosh ◽  
Tilak TVSVGK ◽  
Venkatesan Somasundaram ◽  
Mutreja Deepti
Keyword(s):  
Superior Vena Cava ◽  
Lymphoblastic Leukemia ◽  
Superior Vena ◽  
Tumor Lysis Syndrome ◽  
Vena Cava ◽  
Potassium Phosphate ◽  
Successful Outcome ◽  
Superior Vena Cava Obstruction ◽  
Tumor Lysis ◽  
Life Threatening

Oncological emergencies present in a multitude of manners-structural, metabolic, hematologic, etc. affecting multiple systems, often. Urgent institution of therapy is often required for a successful outcome. Occasionally, the treatment of one emergency can initiate a related or unrelated emergency, necessitating management of all the complications simultaneously. Superior vena cava obstruction (SVCO) is a medical emergency and most often manifests in patients with a malignant disease process requiring immediate diagnostic evaluation and therapy due to its’ life threatening presentation. The management of the SVCO is usually with chemotherapy, radiotherapy or intervention. In cases of large tumor burden, management of SVCO can trigger other complications. Tumor lysis syndrome is an oncologic emergency, which is characterized by a massive release of intracellular potassium, phosphate, and nucleic acid metabolites into the systemic circulation, which can be life-threatening. We present the case of a T-cell acute lymphoblastic leukemia with superior vena cava syndrome, developing tumor lysis syndrome on instituting definitive chemotherapy in a young patient. Doi: 10.28991/SciMedJ-2021-0301-6 Full Text: PDF

Hematologic and Oncologic Emergencies

2019 ◽  
pp. 170-177
Author(s):  
James McCue
Keyword(s):  
Emergency Department ◽  
Standardized Tests ◽  
Tumor Lysis Syndrome ◽  
Clinical Effects ◽  
Tumor Lysis ◽  
Oncologic Emergencies ◽  
First Response ◽  
Appropriate Treatment ◽  
Wide Range ◽  
Life Threatening

Hematologic and oncologic emergencies are an uncommon reason for people to present to the emergency department (ED), but when they do, it is important to know how to diagnose and treat these conditions because many of them are life threatening. Whether it is bleeding due to conditions such as hemophilia, von Willebrand’s disease, warfarin use, or dangerous conditions related to cancer such as tumor lysis syndrome or neutropenic fever, knowing the basics will help you manage these patients and also ace the standardized tests. This chapter presents questions related to the diagnosis, clinical effects, best first response in the ED, and most appropriate treatment of a wide range of these hematologic and oncologic emergencies.

scholarly journals Prevention and Treatment of Tumor Lysis Syndrome in the Era of Onco-Nephrology Progress

2020 ◽  
Vol 45 (5) ◽  
pp. 645-660
Author(s):  
Joanna Matuszkiewicz-Rowinska ◽  
Jolanta Malyszko
Keyword(s):  
High Risk ◽  
Treatment Plan ◽  
Diuretic Therapy ◽  
Tumor Lysis Syndrome ◽  
Phosphate Binders ◽  
Tumor Lysis ◽  
Threatening Condition ◽  
Clinical Consequences ◽  
Life Threatening ◽  
Knowledge Of Cancer

Background: Tumor lysis syndrome (TLS) is an oncologic emergency due to a rapid break down of malignant cells usually induced by cytotoxic therapy, with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and serious clinical consequences such as acute renal injury, cardiac arrhythmia, hypotension, and death. Rapidly expanding knowledge of cancer immune evasion mechanisms and host-tumor interactions has significantly changed our therapeutic strategies in hemato-oncology what resulted in the expanding spectrum of neoplasms with a risk of TLS. Summary: Since clinical TLS is a life-threatening condition, identifying patients with risk factors for TLS development and implementation of adequate preventive measures remains the most critical component of its medical management. In general, these consist of vigilant laboratory and clinical monitoring, vigorous IV hydration, urate-lowering therapy, avoidance of exogenous potassium, use of phosphate binders, and – in high-risk cases – considering cytoreduction before the start of the aggressive agent or a gradual escalation of its dose. Key Messages: In patients with a high risk of TLS, cytotoxic chemotherapy should be given in the facility with ready access to dialysis and a treatment plan discussed with the nephrology team. In the case of hyperkalemia, severe hyperphosphatemia or acidosis, and fluid overload unresponsive to diuretic therapy, the early renal replacement therapy (RRT) should be considered. One must remember that in TLS, the threshold for RRT initiation may be lower than in other clinical situations since the process of cell breakdown is ongoing, and rapid increases in serum electrolytes cannot be predicted.

P276 A meta-analysis on the association of febuxostat compared to allopurinol on blood pressure and major adverse cardiac events (MACE) among adult patients with hyperuricemia

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
M Barrientos ◽  
R A Macabeo ◽  
R A Ragasa
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Uric Acid ◽  
Meta Analysis ◽  
Adult Patients ◽  
Cardiac Events ◽  
Lowering Therapy ◽  
Adverse Cardiac Events ◽  
All Cause Mortality

Abstract Background Increased uric acid levels have been known to be associated with different cardiovascular and renal diseases.  Over the last few years, several studies have examined the role of urate-lowering therapy (ULT) in hypertension and Major Adverse Cardiac Events (MACE) and results are pointing to a potential role of elevated serum uric acid as an emerging independent cardiovascular risk factor. Objective  To determine if urate-lowering therapy (Febuxostat vs Allopurinol) has an association on blood pressure and MACE among adult patients with hyperuricemia. Methodology Randomized controlled trials with outcomes of blood pressure, all-cause mortality, myocardial infarction, and stroke were searched through PubMed and Cochrane database. Results Pooled analysis of studies on hyperuricemic patients showed that Febuxostat 40 mg has no significant difference compared with Allopurinol 100/300mg with respect to lowering diastolic (MD -0.56 with 95% CI of -4.28 to 3.15) and systolic blood pressure (MD -0.72 with 95% CI of -4.87 to 6.31).  No significant differences were also noted on all-cause mortality (OR 1.21 with 95% CI of 0.35 to 4.12) and myocardial infarction (MI) (OR 1.38 with 95% CI of 0.19 to 9.94). Outcomes on non-fatal stroke were only reported by Becker, et. al (2010) with only 2 events reported in the Febuxostat 80 mg group (0.26%) and no event in the Allopurinol group (CI= 0.082 to 1.155). Conclusion The results of this meta-analysis showed that urate-lowering therapy (Febuxostat vs Allopurinol) has no significant association on blood pressure among adult patients with hyperuricemia.  No significant association was also found with respect to all-cause mortality and MI. Outcomes on stroke were inconclusive since only one study reported on its events.

scholarly journals Fatal Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer: A Clinical Case of Rare Oncological Emergency

2020 ◽  
Vol 14 (2) ◽  
pp. 255-260
Author(s):  
Inna Shaforostova ◽  
Robert Fiedler ◽  
Martina Zander ◽  
Johannes Pflumm ◽  
Wolfgang Josef März
Keyword(s):  
Colon Cancer ◽  
Case Reports ◽  
Multiorgan Failure ◽  
Tumor Lysis Syndrome ◽  
Metastatic Colon Cancer ◽  
Tumor Lysis ◽  
Oncological Emergency ◽  
Electrolyte Disturbances ◽  
Life Threatening ◽  
Spontaneous Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) is a potentially life-threatening complication of chemotherapy. It usually occurs in rapidly proliferating hematological malignancies. TLS is deemed spontaneous (STLS) when it occurs prior to any cytotoxic or definite treatment. STLS is extremely rare in solid tumors. Here, we report a rare case of fatal STLS in a 47-year-old woman diagnosed with metastatic colon cancer. The patient developed acute renal failure with anuria, electrolyte disturbances, and metabolic acidosis before initiating chemotherapy. Despite appropriate management of TLS, including renal replacement therapy, she died within a few days from multiorgan failure. Only few other case reports of STLS associated with colon cancer have been reported in the literature.

Sign in / Sign up

Export Citation Format

Share Document