Tumor Lysis Syndrome after the Administration of Ruxolitinib in a Patient with Post-polycythemia Vera Myelofibrosis

Koshiishi, Megumi; Sueki, Yuki; Kawashima, Ichiro; Nakajima, Kei; Mitsumori, Toru; Kirito, Keita

doi:10.2169/internalmedicine.8706-16

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…Patients were not on TLS prophylaxis. In addition, one case report of nonfatal TLS was found in a 62‐year‐old female with JAK2+ post‐PV MF while on treatment with 20 mg twice daily of ruxolitinib 68 . TLS occurred 7 days after initiation of single‐agent ruxolitinib and resulted in electrolyte derangements but no clinical findings of TLS.…”

Section: Resultsmentioning

confidence: 99%

Tyrosine kinase inhibitors and tumor lysis syndrome in hematologic malignancies: A systemic review

Salter

Burns

Fuller

et al. 2022

European J of Haematology

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Background Effective treatments for hematologic malignancies include therapies that target tyrosine kinase (TK) signaling pathways. Tumor lysis syndrome (TLS) is an oncologic emergency that can occur due to rapid turnover following the initiation of treatments for hematologic malignancy. The incidence of TLS is under‐reported and it is unclear as to whether TK inhibitors (TKIs) are associated with TLS. Objective To conduct a systematic review to determine the incidence of TLS with TKIs. Methods A search was performed using EMBASE, MEDLINE, and Web of Science electronic databases, as well as a manual search of the American Society of Hematology and American Society of Clinical Oncology abstract databases. Keywords included: “tumor lysis syndrome,” “tyrosine kinase inhibitors,” “lymphoma,” and “leukemia.” Results We identified a total of 57 publications that commented on the incidence of TLS with TKIs for hematologic malignancy. Thirty‐nine of those publications reported TLS as an adverse event. TLS was described as an adverse event among essentially all the subclasses of TKIs that are used to manage hematologic malignancies. Conclusion The overall number of articles commenting on TLS as an adverse event is sparse and there needs to be more transparency regarding the incidence of TLS when employing newer targeted therapies. Physicians should consider the risk of TLS on an individual basis and the added risk of TLS when using TKIs to treat hematologic malignancy.

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Section: Resultsmentioning

confidence: 99%

Tyrosine kinase inhibitors and tumor lysis syndrome in hematologic malignancies: A systemic review

Salter

Burns

Fuller

et al. 2022

European J of Haematology

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“…Renal complications of myelofibrosis are myriad and commonly involve renal-toxic medications, extramedullary disease in the kidney, 30 , 31 glomerular disease, 32 and cell lysis. 33 , 34 Perhaps patients with more proliferative disease with hyperuricemia and resultant nephrotic stress account for this associated increased mortality imparting a clinical finding and comorbidity linked to disease biology. This may suggest that renal dysfunction, even mild, at the time of diagnosis should be explored further in future iterative prediction models.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific comorbidities as prognostic variables for survival in myelofibrosis

et al. 2023

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Treatment decisions in primary myelofibrosis (PMF) are guided by numerous prognostic systems. Patient specific comorbidities have influence on treatment related survival, and are considered in clinical contexts, but have not been routinely incorporated into current prognostic models. We hypothesized that patient specific comorbidities would inform prognosis and could be incorporated into a quantitative score. All patients with PMF or secondary MF (sMF) with available DNA and comprehensive electronic health record (EHR) data treated at Vanderbilt University Medical Center between 1995-2016 were identified within Vanderbilt's Synthetic Derivative and BioVU Biobank. We recapitulated established PMF risk scores (e.g., DIPSS, DIPSS plus, GPSS, MIPSS 70+) and comorbidities through EHR chart extraction and next generation sequencing (NGS) on biobanked peripheral blood DNA. The impact of comorbidities was assessed via DIPSS-adjusted overall survival using Bonferroni correction. Comorbidities associated with inferior survival include renal failure/dysfunction (hazard ratio [HR] 4.3; 95% CI 2.1-8.9; p = 0.0001), intracranial hemorrhage (HR 28.7; 95% CI 7.0-116.8; p=2.83e-06), invasive fungal infection (HR 41.2; 95% CI 7.2-235.2; p=2.90e-05), chronic encephalopathy (HR 15.1; 95% CI 3.8-59.4; p=0.0001). The extended DIPSS model including all four significant comorbidities showed a significantly higher discriminating power (C-index 0.81; 95% CI 0.78-0.84) than the original DIPSS model (C-index 0.73; 95% CI 0.70-0.77). In summary, we repurposed an institutional biobank to identify and risk-classify an uncommon hematologic malignancy by established (e.g., DIPSS) and other clinical and pathologic factors (e.g., comorbidities) in an unbiased fashion. The inclusion of comorbidities into risk evaluation may augment prognostic capability of future genetics-based scoring systems.

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“…Although various causes of acute renal failure in the MPN such as PMF may occur, the tumor lysis syndrome is not well known. However, the use of JAK2 inhibitors has been recently increasing, and TLS have been reported after drug administration [1,2,4,12]. Cairo and Bishop defined laboratory and clinical TLS by modifying the definitions proposed by Hande-Garrow.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Spontaneous Tumor Lysis Syndrome in Idiopathic Primary Myelofibrosis

Park

2019

Am J Case Rep

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Patient: Male, 51Final Diagnosis: Spontaneous tumor lysis syndrome • idiopathic primary myelofibrosisSymptoms: Abdominal pain • general weaknessMedication: —Clinical Procedure: Continuous renal replacement therapy • bone marrow biopsySpecialty: HematologyObjective:Rare diseaseBackground:Tumor lysis syndrome (TLS) is an oncologic emergency resulting from the massive destruction of tumor cells after cytotoxic chemotherapy for chemosensitive malignancies with a high tumor burden. Its clinical manifestations include severe electrolyte disturbances, metabolic acidosis, acute renal failure secondary to urate deposition in the kidney, heart, and skeletal muscle, and nervous system dysfunction. We report an extremely rare case of spontaneous TLS (STLS) in idiopathic primary myelofibrosis (PMF).Case Report:A 51-year-old Korean man was admitted to our hospital with general weakness and left-side abdominal pain. The patient was diagnosed with acute urate nephropathy with hyperphosphatemia, hyperkalemia, hypocalcemia, and metabolic acidosis. Splenomegaly was accompanied by leukocytosis and a peripheral blood smear revealed immature granulocytes without blast cells. Bone marrow biopsy showed PMF. Initially, we presumed it was a spontaneous tumor lysis syndrome of PMF. We immediately performed emergency hemodialysis. We concluded that the patient, who had chronic hyperuricemia due to undiagnosed PMF, was recently admitted to the emergency room with STLS due to overwork and dehydration.Conclusions:We present an extremely rare case of STLS in idiopathic PMF. The mechanism of chronic hyperuricemia in our case might be rapid cell turnover due to ineffective erythropoiesis of PMF.

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Tumor Lysis Syndrome after the Administration of Ruxolitinib in a Patient with Post-polycythemia Vera Myelofibrosis

Cited by 5 publications

References 19 publications

Tyrosine kinase inhibitors and tumor lysis syndrome in hematologic malignancies: A systemic review

Tyrosine kinase inhibitors and tumor lysis syndrome in hematologic malignancies: A systemic review

Patient-specific comorbidities as prognostic variables for survival in myelofibrosis

A Rare Case of Spontaneous Tumor Lysis Syndrome in Idiopathic Primary Myelofibrosis

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