Dexamethazone-induced Acute Tumor Lysis Syndrome in a T-cell Malignant Lymphoma

Lerza, Roberto; Botta, Marco; Barsotti, Beatrice; Schenone, Eva; Mencoboni, Manlio; Bogliolo, G; Pannacciulli, I; Arboscello, Eleonora

doi:10.1080/10428190290021452

Cited by 34 publications

(18 citation statements)

References 14 publications

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“…The most striking instance is that of acute tumor lysis syndrome that was found in only one case. Corticosteroid use is not the only cause of this syndrome, but it is one of the best-documented ones [11][12][13][14]. In an additional four cases, the lymph node underwent contraction after steroid administration and before the biopsy.…”

Section: Discussionmentioning

confidence: 94%

Alterations in the primary diagnosis of lymphomas pretreated with corticosteroid agents

Kan

Levi

Benharroch³

2011

Leukemia & Lymphoma

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Little is known of the role of preliminary corticosteroids in clinical and morphological modifications and in difficulties in reaching a diagnosis in patients with lymphoma. We identified 31 patients who were given steroids before biopsy for primary diagnosis. We looked for the reason for steroid pretreatment, its dose, and duration. We evaluated the difficulty in reaching the primary diagnosis and whether a secondary diagnosis was made. The patients' slides were reviewed to identify secondary histological changes. Our findings suggest a variable effect of prior glucocorticoids on the clinical and histopathological alterations developing in malignant lymphomas, as well as on the complexity of the process of reaching a diagnosis.

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Section: Discussionmentioning

confidence: 94%

Alterations in the primary diagnosis of lymphomas pretreated with corticosteroid agents

Kan

Levi

Benharroch³

2011

Leukemia & Lymphoma

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“…It is observed that patients with high-grade lymphomas like Burkitt's lymphoma 134,135 and lymphoblastic lymphoma 136 often present with massive disease including pleural effusion and ascites. With the initiation of chemotherapy, especially following administration of dexame-thasone, these patients suffer from acute tumor lysis syndrome.…”

Section: Prognostic Outcome In Lymphoma Cases With Serous Effusions Amentioning

confidence: 99%

Serous effusions in malignant lymphomas: A review

Das

2006

Diagnostic Cytopathology

213

237

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Serous effusions are a common complication of lymphomas. Although the frequency of pleural effusion is 20-30% in non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), the involvement of peritoneal and pericardial cavities is uncommon. Among lymphoma subtypes, T-cell neoplasms, especially the lymphoblastic lymphomas, more frequently involve the serous fluids. The thoracic duct obstruction and impaired lymphatic drainage appear to be the primary mechanism for pathogenesis of pleural effusion in HD and direct pleural infiltration is the predominant cause in NHL. There is wide variation in rate of positive cytologic findings of NHL in pleural effusion (22.2-94.1%). Cytologic features of specific lymphoma subtypes such as lymphoblastic lymphoma, follicular center cell lymphoma, including Burkitt-type lymphoma, marginal zone lymphoma, MALT lymphoma, and anaplastic large-cell lymphoma, etc., have been described in the literature. The differential diagnostic problems of lymphomas in serous effusions include reactive lymphocytoses, early involvement by lymphomatous process, small round-cell tumors (SRCT), and presence of look-alike of Reed-Sternberg cells. To overcome these difficulties, various ancillary studies, including immunocytochemistry (ICC), morphometry, flow cytometry (FCM), and cytogenetics/molecular genetics (PCR, in-situ hybridization, and Southern blotting), have been performed on effusion specimens. ICC not only distinguishes lymphomas from reactive lymphocytoses and SRCTs, it significantly modifies the morphologic diagnosis to achieve a better classification of lymphomas. Combined morphology and immunophenotyping by FCM, has a sensitivity as well as specificity of 100%. Morphometry also distinguishes reactive lymphocytoses from malignant lymphoma with a high degree of sensitivity (>85%) and specificity (>95%). Limitations of individual ancillary techniques can be overcome by using multiple parameters. Although lymphomas rarely present as serous effusions without the involvement of other thoracic and extrathoracic sites, a small group of lymphomas called primary effusion lymphomas (PEL) exhibit exclusive or dominant involvement of serous cavities, without a detectable solid tumor mass. This body cavity based lymphoma (BCBL) is a distinct clinicopathologic entity and is found predominantly in AIDS patients with preexisting Kaposi sarcoma. In the absence of obstructive or infiltrative tumor mass, its pathogenesis has been attributed to stimulation by vascular endothelial growth factor (VEGF)/vascular permeability factor (VPF), leading to vascular leakage. Cytomorphologically, PEL is usually a large-cell lymphoma, which appears to bridge features of large-cell immunoblastic and anaplastic large-cell lymphoma (ALCL). Most of these cases comprise a unique subgroup of B-cell lymphoma, with features of both high-grade anaplastic and B-immunoblastic lymphoma, but T-cell and/or natural killer cell immunophenotypes are described. Its association with various viral DNAs has been studied in detail by molecular techn...

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“…We searched the medical literature using the Medline/Pubmed databases from 1966 through 2006. Though steroid-associated acute TLS was described in the literature in hematologic tumors [9][10][11], we strongly believe that the main reason for acute TLS in our case was the rituximab therapy. He was started on high dose corticosteroids the day before rituximab, but did not have manifestations of TLS nor did his circulating blasts decrease in number, but did so within few hours after initiation of a very small dose of rituximab.…”

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confidence: 53%

Acute tumor lysis syndrome after rituximab administration in Burkitt’s lymphoma

2008

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Rituximab (Rituxan, Mabthera) is an anti-CD20 monoclonal antibody that mediates killing of CD20+ B-lymphocytes by a combination of complement-mediated lysis and antibody-dependent cytotoxicity [1]. It is considered a safe medication, and infusion-related side effects are generally manageable. These include fever, chills and rigors, and they occur in 50% of patients [2]. Rituximab has been considered a nontoxic alternative to chemotherapy regimens and has become part of standard therapy for patients with CD20-expressing B-cell lymphoma [3]. In patients with a large number of CD20+ cells, tumor lysis may occur. Acute tumor lysis syndrome (TLS) caused by rituximab has been reported in two patients with chronic lymphocytic leukemia [4,5] and in three patients with nonHodgkin's lymphoma (NHL) [4,6,7]. We report another case of a patient with Burkitt's lymphoma who experienced acute TLS upon treatment with rituximab.A 53-year-old man presented to a hospital in Saudi Arabia in January 2003 with melena and abdominal pain. He reported abdominal pain and easy fatiguability of 10-day duration with no other symptoms. Esophagogastroduodenoscopy and biopsy of a gastric ulcer showed gastric lymphoma, large B-cell type. Complete blood count (CBC) showed severe anemia and 19% immature cells, and bone marrow aspirate (BMA) showed infiltration with blasts. Computerized tomography (CT) of the abdomen and pelvis revealed multiple enlarged intra-abdominal lymph nodes at the lesser curvature of the stomach and the mesenteric area. The patient was transfused with four units of packed red blood cells and was transferred to the American University of Beirut-Medical Center (AUB-MC).Upon presentation to AUB-MC, the patient was icteric and sick looking with pedal edema but no peripheral adenopathy or hepatosplenomegaly. His vital signs were within normal limits. CBC showed a white blood cell (WBC) count of 40.0 9 10 3 /lL with 64% blasts, hemoglobin of 10.8 g/ dL, and platelets 40 9 10 3 /lL. His chemistries showed the following: uric acid 14.7 mg/dL, creatinine 1 mg/dL, BUN 13 mg/dL, alkaline phosphatase 636 IU/L, c-GT 1,077 IU/L, SGPT 338 IU/L, LDH 7,266 IU/L (normal \ 480), INR 1, and fibrinogen 5.2 g/L. His echocardiogram was normal. CT scan showed an antral gastric mass and multiple abdominal lymph nodes and splenomegaly. Repeat BMA showed heavy infiltration by lymphoma cells. Flow cytometry on the peripheral blood showed B cell lymphoma with lambda light chain restriction. Bone marrow karyotype revealed t(8;22) (q24.3;q11.3)(9/11 cells) and der(1) in 82% of cells analyzed. The patient was diagnosed with Burkitt's lymphoma.Our patient was 164 cm in height and 106 kg in weight. He was started on allopurinol 300 mg daily, IV hydration and prednisone 100 mg PO. Repeat blood studies 24 h from admission showed a WBC count of 34.7 9 10 3 /uL with 81% blasts, uric acid 10.9 mg/dL, creatinine 1.2 mg/dL, BUN 25 mg/dL, Na 141 mmol/L, K 3.0 mmol/L, Cl 95 mmol/L, HCO3 25 mmol/L, Mg 2.03 mg/dL, Ca 8.5 mg/dL, PO4 3.8 mg/dL, and LDH 7,500 IU/L. The pa...

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Dexamethazone-induced Acute Tumor Lysis Syndrome in a T-cell Malignant Lymphoma

Cited by 34 publications

References 14 publications

Alterations in the primary diagnosis of lymphomas pretreated with corticosteroid agents

Alterations in the primary diagnosis of lymphomas pretreated with corticosteroid agents

Serous effusions in malignant lymphomas: A review

Acute tumor lysis syndrome after rituximab administration in Burkitt’s lymphoma

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