Spontaneous Tumor Lysis Syndrome in Diffuse Large B-cell Lymphoma: Early Diagnosis and Management

Abstract

Spontaneous tumor lysis syndrome is a rare oncological emergency associated with multiorgan failure. It is characterized by an elevation of uric acid, hyperphosphatemia, hypocalcemia, hyperkalemia and renal failure in the setting of no active chemotherapy as a result of lysis of massive tumor burden. Early recognition of the disease and prompt management would affect morbidity and mortality. We present the case of an 80-year-old Caucasian male with a history of recently diagnosed diffuse large B-cell lymphoma who had worsening fatigue, weakness and decreased appetite for three days. On admission, laboratory investigations were significant for elevated creatinine, uric acid, and phosphorous. He was started on hemodialysis and rasburicase in view of hyperuricemia. Subsequently, chemotherapy was started. He tolerated chemotherapy initially but later developed multiorgan failure. His family then opted for comfort measures and the patient passed away soon after. In conclusion, spontaneous tumor lysis syndrome is a common association with hematological cancers. Prophylaxis with allopurinol and rasburicase is recommended in all patients who are at an increased risk for tumor lysis syndrome.

An HIV Associated Plasmablastic Lymphoma With Spontaneous Tumor Lysis Syndrome

“…Spontaneous tumor lysis syndrome occurs rarely but has fatal consequences. Clinicians should be wary about the intrinsic and extrinsic risk factors with special attention to malignancies with a high proliferation rate [15].…”

Skin involvement in Burkitt lymphoma: rare clinical case

“…С другой стороны, развитие синдрома острого лизиса опухоли могло произойти в связи с хирургическим воздействием (повышение внутрибрюшного давления, манипу-ляции в ходе биопсии) [10]. Но не стоит забывать и о синдроме спонтанного опухолевого лизиса при ЛБ, описанном в литературе [11][12][13][14]. Провести адекватную интенсивную терапию с привлечением методов заместительной почечной терапии оказалось возможно в условиях реанимации и интенсивной терапии.…”

A rare case of spontaneous tumor lysis syndrome in multiple myeloma

“…TLS occurs in 5%-20% of malignancies, typically occurring 48-72 hours after patients with high-grade rapidly proliferating hematologic malignancies initiate chemotherapy or targeted therapy [1]. Much less frequently, patients may have spontaneous TLS with a similar constellation of disturbances, which has been observed in aggressive lymphomas such as Burkitt's lymphoma and with acute leukemias with markedly elevated cell counts [2]. Here we describe a case of spontaneous TLS from multiple myeloma, which is unusual in that it is considered an indolent hematologic malignancy.…”