Ixazomib-associated tumor lysis syndrome in multiple myeloma

Abstract

Rationale: Tumor lysis syndrome (TLS) is an oncologic emergency, but its incidence in MM is rare. To our knowledge, ixazomib has not been associated with TLS in MM. Patient concerns: The patient developed TLS after 10 days of treatment with ixazomib, accompanied by renal failure of hyperuricemia, hyperkalemia, and hyperphosphatemia. Diagnoses: MM (type IgG λ) was diagnosed according to the diagnostic criteria established by the International Myeloma Working Group and classified stage IIA by the International Staging System. TLS was diagnosed after the patient met all three criteria of the Cairo-Bishop TLS scoring system. Interventions: From April 8, 2017, the patient was treated with 3 courses of bortezomib, cyclophosphamide, and dexamethasone chemotherapy. From August 18, she received five courses of bortezomib combined with DCEP chemotherapy. On May 21, 2018 treatment was switched to lenalidomide, bortezomib, and dexamethasone for four courses. Ixazomib was started on October 10, 2018 with cyclophosphamide and dexamethasone. On October 19, 2018 vigorous intravenous hydration with sodium bicarbonate was initiated and peroral febuxostat was administered. Outcomes: On October 19, changes in hematological indicators raised concern for TLS worsening kidney function and decreasing urine output. She refused renal replacement treatment for TLS-induced acute kidney injury. On October 26th, the patient died of respiratory failure. Lessons: This case highlights the need to vigilant for the occurrence of TLS in patients undergoing MM treatment with ixazomib. Higher baseline uric acid or creatinine, rapidly progressive anemia, and raised lactate dehydrogenase (LDH) and β2-microglobulin may be surrogate markers of TLS.

Mechanism of PDZK1 in Hepatocellular Carcinoma Complicated with Hyperuricemia

“…Hyperuricemia is a metabolic disease, which can be secondary to gout and increase the risk of other diseases, especially cardiovascular diseases, metabolic diseases, and kidney diseases, such as metabolic syndrome or heart failure [27,28]. In recent years, through various clinical observations and studies, it has been found that hyperuricemia maybe an independent risk factor for a variety of solid tumors, including prostate cancer, colon cancer, and breast cancer [29][30][31][32][33][34]. In our study, the mRNA expression of PDZK1 was signifcantly increased after HCC after diferent concentrations of soluble uric acid treatment, which is similar to Chen et al results [35].…”

Comprehensive Analysis of Ixazomib-Induced Adverse Events Using the Japanese Pharmacovigilance Database

“…These findings may be attributed to decreased immunity and increased susceptibility to infection. Additionally, AE signals of cardiac failure and TLS were noted, and both were associated with ≥10% fatal outcomes; however, there are no reports on either AE in clinical trials, with case reports [8,9] documented outside Japan. These findings indicate a risk of developing cardiac failure and TLS in the Japanese popu- lation.…”