Cytokine release syndrome and tumor lysis syndrome in a multiple myeloma patient treated with palliative radiotherapy: A case report and review of the literature

Cailleteau, Axel; Touzeau, Cyrille; Jamet, Bastien; Guimas, V.; Jouglar, Emmanuel; Supiot, S.

doi:10.1016/j.ctro.2021.11.004

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Elevation of serum IL-6 levels was reported in a patient with Hodgkin's lymphoma who developed TLS after chemotherapy (30). Recently, Supiot et al reported that a patient with MM simultaneously developed TLS and CRS after radiotherapy (31). Systemic inflammatory response syndrome and multiple organ dysfunction were observed in patients with TLS and hematological malignancies or solid tumors (32).…”

Section: Discussionmentioning

confidence: 99%

Incidence, clinical characteristics and prognosis of tumor lysis syndrome following B-cell maturation antigen-targeted chimeric antigen receptor-T cell therapy in relapsed/refractory multiple myeloma

Zhang

Jing

et al. 2023

Front. Immunol.

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Background aimsB-cell maturation antigen (BCMA)-targeted chimeric antigen receptor-T cell (CAR-T) therapy is used for refractory or relapsed multiple myeloma (r/r MM). However, CAR-T-related tumor lysis syndrome (TLS) has been observed. We aimed to elucidate the incidence, clinical and laboratory characteristics, and prognosis of CAR-T cell-related TLS.MethodsPatients (n=105) with r/r MM treated with BCMA-targeted CAR-T cell therapy were included. Patient characteristics, laboratory parameters, and clinical outcomes were assessed.ResultsEighteen (17.1%) patients developed TLS after BCMA-targeted CAR-T cell therapy. The median time till TLS onset was 8 days. Patients with TLS had steep rise in uric acid (UA), creatinine, and lactate dehydrogenase (LDH) within 6 days following CAR-T cell infusion and presented earlier and persistent escalation of cytokines (C-reactive protein [CRP], interleukin-6 [IL-6], interferon-γ [IFN-γ], and ferritin levels). All 18 patients had cytokine release syndrome (CRS), of which 13 (72.2%) developed grade 3–4 CRS. Three of 18 patients (16.7%) developed immune effector cell-associated neurotoxicity syndrome (ICANS): two patients with grade 1 ICANS and one with grade 2 ICANS. TLS development had a negative effect on the objective response rate (77.8% in the TLS group vs. 95.4% in the non-TLS group, p<0.01). During the median follow-up of 15.1 months, the median PFS was poorer of patients with TLS (median: 3.4 months in the TLS group vs. 14.7 months in the non-TLS group, p<0.001, hazard ratio [HR]=3.5 [95% confidence interval [CI] 1.5–8.5]). Also, TLS development exhibited significant effects on OS (median: 5.0 months in the TLS group vs. 39.8 months in the non-TLS group, p<0.001, hazard ratio [HR]=3.7 [95% CI 1.3–10.3]). TLS was associated with a higher tumor burden, elevated baseline creatinine and UA levels, severe CRS, pronounced CAR-T cell expansion, and corticosteroid use.ConclusionTLS is a frequently observed CAR-T therapy complication and negatively influences clinical response and prognosis. Close monitoring for TLS should be implemented during CAR-T cell therapy, especially for those at high TLS risk.

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Section: Discussionmentioning

confidence: 99%

Incidence, clinical characteristics and prognosis of tumor lysis syndrome following B-cell maturation antigen-targeted chimeric antigen receptor-T cell therapy in relapsed/refractory multiple myeloma

Zhang

Jing

et al. 2023

Front. Immunol.

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“…Table II shows the available reports on RT-induced TLS (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Two studies reported three cases of RT-induced TLS in MM (19,20). In another study, all 16 cases developed TLS after the initiation of RT (1).…”

Section: Discussionmentioning

confidence: 99%

Palliative Radiotherapy Induced Severe Tumor Lysis Syndrome in a Patient With Multiple Myeloma With Skin Involvement: A Case Report and Review of Literature

Kawamoto

Karino

Muramoto

et al. 2023

CDP

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Background/Aim: Radiotherapy (RT) has been rarely reported as a cause of tumor lysis syndrome (TLS). Therefore, the patient characteristics and details of RT-induced TLS remain unclear, which may delay diagnosis. Herein, we report a case of palliative RT-induced severe TLS in a patient with multiple myeloma (MM) with skin involvement along with literature review. Case Report: A 75-year-old female with MM was referred to our department in February 2021 because of swelling and pruritus of the bulky tumor on her right breast and severe left leg pain. She had received chemotherapies and autologous peripheral blood stem cell transplantations since October 2012. We administered palliative RT (a single 8 Gy fraction) to the right breast, left tibia, and femur. On day 7 after RT, a shrinkage effect was observed on the right breast lesion, and left leg pain was relieved. Her laboratory results showed hyperuricemia, hyperphosphatemia, and hypercreatininemia. Initially, we considered acute renal failure (ARF) due to MM progression and planned for a follow-up after 1 week. On day 14 after RT completion, she experienced vomiting and anorexia. Her laboratory results became worse. She was admitted with the diagnosis of TLS and received intravenous fluid hydration and allopurinol. Unfortunately, the evolution was marked by severe clinical deterioration with anuria and coma, leading to death on day 35 after RT. Conclusion: It is important to determine whether ARF is due to MM progression or TLS. The occurrence of TLS should be considered in the case of a rapidly shrinking bulky tumor while receiving palliative RT.

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“…There are a few reported cases of radiation-induced TLS, with doses as low as 1.5 Gy to HMs and 3 Gy to solid histologies not known for their high risk of TLS. 8 , 9 , 10 , 11 , 12 While additional individual risk factors certainly contributed to TLS in those cases, we also wonder if a lower-dose quad shot might have been indicated given the radiosensitive nature of DLBCL. There are current efforts to dose deescalate in orbital mucosa-associated lymphoid tissue, 13 gastric mucosa-associated lymphoid tissue, 14 and follicular lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Tumor Lysis Syndrome After Quad Shot in Diffuse Large B-Cell Lymphoma

Newbury

Ganguly

Henson

2023

Advances in Radiation Oncology

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Cytokine release syndrome and tumor lysis syndrome in a multiple myeloma patient treated with palliative radiotherapy: A case report and review of the literature

Cited by 4 publications

References 26 publications

Incidence, clinical characteristics and prognosis of tumor lysis syndrome following B-cell maturation antigen-targeted chimeric antigen receptor-T cell therapy in relapsed/refractory multiple myeloma

Incidence, clinical characteristics and prognosis of tumor lysis syndrome following B-cell maturation antigen-targeted chimeric antigen receptor-T cell therapy in relapsed/refractory multiple myeloma

Palliative Radiotherapy Induced Severe Tumor Lysis Syndrome in a Patient With Multiple Myeloma With Skin Involvement: A Case Report and Review of Literature

Case Report: Tumor Lysis Syndrome After Quad Shot in Diffuse Large B-Cell Lymphoma

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