B-Cell Lymphoma, Thiamine Deficiency, and Lactic Acidosis

Masood, Umair; Sharma, Abha; Nijjar, Sonny; Sitaraman, Karthikeyan

doi:10.1080/08998280.2017.11929534

Cited by 17 publications

(17 citation statements)

References 7 publications

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“…Intracellular acidosis may slow lactate production and alkalanisation with sodium bicarbonate may potentiate lactate production and lead to fluid overload; therefore, may be counterproductive 5. Renal replacement therapy in form of dialysis may not sufficiently remove accumulated lactate 6 7. Thiamine is a pyruvate dehydrogenase enzyme cofactor which promotes aerobic glycosylation pathway and is recommended by some in the management of LA 6.…”

Section: Discussionmentioning

confidence: 99%

Type B lactic acidosis due to Warburg effect in a child presenting with T cell acute lymphoblastic leukaemia: a milder phenotype

et al. 2020

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Lactic acidosis (LA) is characterised by persistently increased blood lactate >5 mmol/L. Type A LA due to anaerobic glycolysis is frequently seen during management of haematological malignancies. A rare form of LA known as type B LA, which occurs as a result of metabolic dysregulation at cellular level has been described recently. This has been reported to be because of Warburg effect (WE) or aerobic glycolysis, which is seen in cancerous cells as they rely on aerobic glycolysis rather than oxidative phosphorylation for energy generation. Presence of type B LA at initial presentation of haematological malignancies is a poor prognosticating factor and has rarely been reported in children. We present a child with T cell acute lymphoblastic leukaemia with mild phenotype of type B LA due to WE. She responded dramatically to definitive chemotherapy and tolerated intensive phase of chemotherapy without any significant morbidity.

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Section: Discussionmentioning

confidence: 99%

Type B lactic acidosis due to Warburg effect in a child presenting with T cell acute lymphoblastic leukaemia: a milder phenotype

et al. 2020

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“…Moreover, some chemotherapy (e.g., methotrexate) may limit the cellular bioavailability of thiamine ( 24 ). Thiamine plays a key role as a pyruvate dehydrogenase enzyme cofactor, promoting the aerobic glycosylation pathway ( 25 ). Therefore, we recommend routine thiamine supplementation.…”

Section: Discussionmentioning

confidence: 99%

The Warburg Effect as a Type B Lactic Acidosis in a Patient With Acute Myeloid Leukemia: A Diagnostic Challenge for Clinicians

Brault¹,

Zerbib²,

Delette³

et al. 2018

Front. Oncol.

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IntroductionThe Warburg effect (WE) is an uncommon cause of type B lactic acidosis (LA) due to a deregulation of carbohydrate metabolism in neoplastic cells where lactic fermentation predominates over oxidative phosphorylation regardless of the oxygen level.Case presentationWe report the case of a 57-year-old man presenting with concomitant acute myeloid leukemia and type B LA with asymptomatic hypoglycemia. We did not find arguments for a septic state, liver dysfunction, or acute mesenteric ischemia. The WE was suspected, and chemotherapy was immediately undertaken. We observed a rapid and sustained decrease in lactate level and normalization of blood glucose. Unfortunately, we noted a relapse of acute leukemia associated with WE soon after treatment initiation and the patient died in the Intensive Care unit.DiscussionSome patients may present complications directly related to an underlying hematological malignancy. The WE is one of these complications and should be suspected in patients with both hypoglycemia and LA. We propose a checklist in order to help clinicians manage this life-threatening complication. Before considering WE, clinicians should eliminate diagnoses such as septic shock or mesenteric ischemia, which require urgent and specific management.ConclusionThe diagnosis of WE can be challenging for clinicians in the Hematology department and the Intensive Care unit. Prompt diagnosis and rapid, adapted chemotherapy initiation may benefit patient survival.

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“…Multiple mechanisms have been proposed for elevated LA in malignancy, including decreased hepatic clearance of LA, thiamine deficiency, and increased production of LA by the tumor cells themselves by utilizing anaerobic glycolysis, a phenomenon referred to as the “Warburg” effect [ 5 , 13 - 16 ].…”

Section: Discussionmentioning

confidence: 99%

Persistent Lactic Acidosis: Thinking Outside the Box

Arif

Zahid

Kaura

2018

Cureus

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A 54-year-old male presented with possible sepsis and elevated serum lactic acid (LA) of 18.7 mmol/L. Despite the sepsis treatment protocol and the management of other causes of type A lactic acidosis, his LA remained elevated. Herein, we present a case of type B lactic acidosis in the setting of a diffuse large B cell lymphoma. The proposed mechanisms of persistent lactic acidosis in malignancy are highlighted in this case report.

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B-Cell Lymphoma, Thiamine Deficiency, and Lactic Acidosis

Cited by 17 publications

References 7 publications

Type B lactic acidosis due to Warburg effect in a child presenting with T cell acute lymphoblastic leukaemia: a milder phenotype

Type B lactic acidosis due to Warburg effect in a child presenting with T cell acute lymphoblastic leukaemia: a milder phenotype

The Warburg Effect as a Type B Lactic Acidosis in a Patient With Acute Myeloid Leukemia: A Diagnostic Challenge for Clinicians

Persistent Lactic Acidosis: Thinking Outside the Box

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