Abstract: SA-PO252
Spontaneous Tumor Lysis Syndrome
Session Information
- Onconephrology: Immunological Cross-Talk
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Suleiman, Saeed, Al Balqa Applied University, Al-Salt, Jordan
- Russell, Charles, University of South Florida, Tampa, Florida, United States
- Punchayil Narayanankutty, Naveen, University of South Florida, Tampa, Florida, United States
- Srivastava, Kartikeya, Srivastava Orthopaedic and Fracture Care Centre, Agra, India
- Chirumamilla, Punith Chowdary, Guntur Medical College, Guntur, India
Introduction
Tumor lysis syndrome is a life-threatening oncological emergency characterized by metabolic abnormalities including hyperuricemia, hyperphosphatasemia, hyperkaliemia and hypocalcemia. These metabolic complications predispose the cancer patient to clinical toxicities including renal insufficiency, cardiac arrhythmias, neurological complications and potentially sudden death.
TLS is typically associated with the start of chemotherapy; however, in some instances, spontaneous TLS may occur without prior exposure to chemotherapy. STLS is typically seen in high-grade hematological malignancies such as B-cell non-Hodgkin lymphoma.
Case Description
A 68-year-old male with a history of hypertension presented with fatigue, poor appetite, and generalized weakness. He had been previously admitted to another hospital for hematemesis and was diagnosed with high-grade B-cell lymphoma found in a gastric ulcer biopsy. He developed acute kidney injury and urinary obstruction during that hospitalization. On presentation to our hospital, he denied other symptoms and had no further episodes of hematemesis.
Initial lab results showed extremely high uric acid (>33.1 mg/dl), abnormal values for phosphorus, calcium, and creatinine. The patient was diagnosed with AKI secondary to acute spontaneous TLS. Standard treatment was initiated with Rasburicase, the patient needed hemodialysis. Chemotherapy was initiated for the lymphoma.
After five days, the patient's lab values improved, and he remained stable, transitioning to continuous renal replacement therapy.
Discussion
In conclusion, this case report underscores the importance of recognizing and promptly treating STLS in patients with high-grade hematological malignancies. Even in the absence of chemotherapy, STLS can occur and lead to severe metabolic abnormalities and renal dysfunction. Early intervention with appropriate pharmacological and supportive measures is crucial to prevent complications and improve patient outcomes. Further research and awareness are needed to better understand the pathophysiology and optimal management of STLS.
| Day 0 | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | |
| Uric Acid (mg/dl) | >33.1 | 7.3 | 3.5 | 3.2 | 2.6 | 1.8 |
| Phosphorus (mg/dl) | 16.9 | 10.4 | 7.6 | 4.1 | 3.2 | 2.5 |
| Calcium (mg/dl) | 6.2 | 6.9 | 7.6 | 6.2 | 6.4 | 6.4 |
| Creatinine (mg/dl) | 6.5 | 5.5 | 2.9 | 1.7 | 1.4 | 1.1 |
| BUN (mg/dl) | 119 | 89 | 61 | 48 | 26 | 33 |