S Cyclophosphamide/fludarabine Tumour lysis syndrome: case reportA 78-year-old woman developed tumour lysis syndrome (TLS) after treatment with cyclophosphamide and fludarabine.The woman, with a history of chronic lymphocytic leukaemia [CLL] and debilitating respiratory failure because of large amount of pleural effusion due to the infiltration of CLL cells, received oral fludarabine at 30mg and oral cyclophosphamide at 200mg for 5 days. On the fifth day of chemotherapy, she developed nausea, lethargy and dehydration. Investigations showed significant decrease in WBC count but increased in LDH. Acute renal failure was observed with elevated serum creatinine and urea nitrogen, with excessively increased uric acid and high level of potassium. She was diagnosed with clinical TLS.The woman received sodium chloride, furosemide, glucose, insulin, rasburicase and emergency haemodialysis. Subsequently, her laboratory data and ECG showed improvement and she was able to discontinue dialysis successfully on day 8.However, due to progressive deterioration of her chest X-ray results, she received two more courses of oral fludarabine and cyclophosphamide along with rituximab, with TLS prophylaxis with allopurinol.Author comment: "[W]e presented a CLL case with TLS after oral fludarabine and cyclophosphamide therapy. The destruction of infiltrated CLL cells in the pleural effusion might be attributed to the development of TLS." Nakazawa H, et al. Tumor lysis syndrome in a chronic lymphocytic leukemia patient with pleural effusion after oral fludarabine and cyclophosphamide therapy.