Spontaneous Acute Tumor Lysis Syndrome in Acute Myeloid Leukemia? A Single Case Report with Discussion of the Literature

Abstract

Acute tumor lysis syndrome (ATLS), a condition which results from a rapid destruction of tumor cells with massive release of cellular breakdown products, has been well described following the treatment of various malignancies. However, only a handful of cases of spontaneous ATLS have been reported in the literature. We describe the first reported case of spontaneous ATLS in acute myeloid leukemia (AML). A previously healthy 63 year old woman presented with a two month history of fatigue and a one week history of easy bruising. On admission she had oliguric acute renal failure, with marked elevation in serum uric acid and phosphate. A bone marrow biopsy showed AML M7 with fibrosis. The renal failure resolved with supportive care and institution of allopurinol therapy. Following this, AML induction chemotherapy resulted in complete remission. Her biochemical and clinical course were very similar to the classical ATLS seen in patients after chemotherapy. Therefore, this case represents a rare instance of acute renal failure from spontaneous ATLS, and in our opinion the first reported occurrence of spontaneous ATLS associated with AML.

Comparative Evaluation of Single Fixed Dosing and Weight‐Based Dosing of Rasburicase for Tumor Lysis Syndrome

“…Spontaneous tumor lysis syndrome has been described in patients with AML, non‐Hodgkin's lymphoma and other lymphomas, and solid tumors . The use of rasburicase in the prophylactic setting has been shown to be effective for maintaining normal uric acid levels …”

Tumor Lysis Syndrome in Solid Tumors: A Comprehensive Literature Review, New Insights, and Novel Strategies to Improve Outcomes

“…TLS typically occurs in patients with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). The incidence of TLS comprises about 10% among patients undergoing remission-induction chemotherapy [7,8]. It is essential to recognize that the relatively recent and ongoing progress in cancer therapy has led to the rising incidence of TLS in solid tumors that were previously rarely thought to be associated [3].…”

A 78-Year-Old Man with Acute Myeloid Leukemia (AML) and Acute Renal Failure

“…Spontaneous tumor lysis has in rare cases been described in patients with acute leukemia [12,13] and can also lead to acute renal failure at presentation, but the characteristic electrolyte abnormalities (hypokalemia and hypophosphatemia) associated with the “lysozyme kidney” can help distinguish between the 2 syndromes. Another mechanism that can explain renal failure at presentation is leukemic thrombi in the renal vasculature, but this seems to be rare [14].…”