Tumor Lysis Syndrome

Williams, Shelly M.; Killeen, Anthony A.

doi:10.5858/arpa.2017-0278-rs

Cited by 53 publications

(50 citation statements)

References 26 publications

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“…However, the type of therapy is a known TLS risk factor [1][2][3][4][5][6]. TLS risk for chronic lymphocytic leukemia (CLL) is classi ed as low; however, the risk increases to an intermediate level when targeted therapies (rituximab) or purine analogues ( udarabine) are used [3].…”

Section: Discussionmentioning

confidence: 99%

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

Kondo

Hotta

Yamauchi

et al. 2020

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

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

Kondo

Hotta

Yamauchi

et al. 2020

Preprint

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“…Regardless of the treatment strategy, MM is always classified as a low-risk disease for developing TLS despite an increasing number of novel therapies that can achieve antitumor responses, such as proteasome inhibitors, immunomodulatory drugs, and anti-CD38 antibodies [3]. The type of therapy is a known TLS risk factor [1][2][3][4][5][6]. Actually, the TLS risk for chronic lymphocytic leukemia is classified as low; however, the risk increases to an intermediate level when targeted and biological therapies (fludarabine or rituximab) are used [3].…”

Section: Discussionmentioning

confidence: 99%

“…This occurs following the initiation of cancer treatments, which include the administration of anticancer agents. The release of intracellular components can cause hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, which can lead to renal failure, arrhythmias, seizures, and even death [1][2][3][4][5][6]. In 2004, TLS was subdivided into laboratory TLS (LTLS) and clinical TLS (CTLS) according to the Cairo-Bishop definition [2].…”

Section: Introductionmentioning

confidence: 99%

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

Kondo

Hotta

Yamauchi

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Many novel medicines such as proteasome inhibitors have been developed during the last decade to treat multiple myeloma. Although multiple myeloma is defined as a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. In fact, there have been some prior reports of bortezomib-induced TLS in patients with multiple myeloma. However, almost all of them have been case reports or case series. Thus, we investigated the risk factors for TLS 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 LTLS and several parameters previously reported to be associated with increased risk. Results This study included 210 patients, seventeen (8.1%) and seven (3.3%) patients with LTLS and CTLS, respectively. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between the patients with and without LTLS. Multivariate analyses revealed that LTLS 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 LTLS (odds ratio = 8.51, P = 0.046). Conclusion In the present study, we investigated the risk factors for developing TLS 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 multiple myeloma patients. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, as an increasing number of novel therapies can achieve high antitumor responses.

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“…Generally, the risk of TLS in multiple myeloma is low, given the disease's low proliferation rate. However, after the introduction of proteasome inhibitors, an increasing frequency of TLS has been reported, with an incidence of 1.4-5% for bortezomib, 0.4-4.3% for carfilzomib, and 2.4% for oprozomib [9,[56][57][58].…”

Section: Proteasome Inhibitorsmentioning

confidence: 99%

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

Matuszkiewicz‐Rowińska

Małyszko²

2020

Kidney Blood Press Res

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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.

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Tumor Lysis Syndrome

Cited by 53 publications

References 26 publications

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

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

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

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

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