Management of Tumor Lysis Syndrome in Patients With Multiple Myeloma During Bortezomib Treatment

Wang, Li; Jian, Yuan; Yang, Guangzhong; Gao, Wen; Wu, Yin; Zuo, Lihong

doi:10.1188/15.cjon.e4-e7

Cited by 7 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the presence of uric acid crystals on urine microscopy, the most likely explanation for the patient’s kidney injury was his profound hyperuricemia leading to a urate crystal nephropathy. While many of the patients in the studies listed [ 2 , 5 , 6 ] had elevated uric acid levels, the uric acid level from our patient was excessively elevated, and uric acid crystals were noted on his urine microscopy as well as non-obstructing stones on his renal ultrasound. To our knowledge, elotuzumab does not have any direct effect on uric acid metabolism.…”

Section: Discussionmentioning

confidence: 57%

“…Consistent with this, the recent appearance of circulating plasmacytes on our patient’s blood differential suggests a more highly proliferative state, which may have been his major risk factor for TLS development. Rare cases of TLS have been reported with most of the other chemotherapeutic treatments of MM, including bortezomib [ 5 ], melphalan [ 2 ], cyclophosphamide [ 2 ], or thalidomide [ 6 ]. The patient had been started on lenalidomide 1 week prior to receiving elotuzumab.…”

Section: Discussionmentioning

confidence: 99%

“…As described above, TLS is a relatively rare occurrence in MM. Many of these cases usually occur in a setting of high tumor proliferation [ 1 , 2 , 4 ] or in cases treated with bortezomib [ 5 ], melphalan [ 2 ], cyclophosphamide [ 2 ], or thalidomide [ 6 ]. Elotuzumab is a monoclonal antibody against signaling lymphocytic activation factor molecule F7 (SLAMF7), which causes the activation of natural killer cells against the MM cells and direct antibody-mediated cytotoxicity [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A case of tumor lysis syndrome and acute renal failure associated with elotuzumab treatment in multiple myeloma

Atchison¹,

Humes²

2017

CNCS

View full text Add to dashboard Cite

Renal dysfunction is a common comorbidity of multiple myeloma. However, tumor lysis syndrome is a rare cause of renal dysfunction in multiple myeloma. Elotuzumab is a newly US FDA-approved monoclonal antibody used in the treatment of refractory multiple myeloma. To our knowledge, elotuzumab has not been associated with a case of tumor lysis syndrome. We present the case of a patient who developed clinical tumor lysis syndrome 1 week after treatment with elotuzumab accompanied by renal failure with hyperphosphatemia, hyperkalemia, and profound hyperuricemia. His course was further complicated by significant epistaxis from the accumulation of dabigatran in acute renal failure. In spite of treatment with rasburicase and hemodiafiltration, the patient decompensated and eventually died. Risk factors for the development of tumor lysis syndrome in multiple myeloma are discussed.

show abstract

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A case of tumor lysis syndrome and acute renal failure associated with elotuzumab treatment in multiple myeloma

Atchison¹,

Humes²

2017

CNCS

View full text Add to dashboard Cite

show abstract

“…In a study of 17 patients with relapsed myeloma, three developed TLS, all three patients having significant disease burden and elevated LDH and β2-microglobulin levels. [ 9 , 10 ] TLS was also reported to be found in patients who were treated with thalidomide, [ 13 ] carfizomib, [ 14 ] and elotuzumab. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Ixazomib-associated tumor lysis syndrome in multiple myeloma

Jin

Yang²,

Chen³

et al. 2020

Medicine

View full text Add to dashboard Cite

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.

show abstract

“…The resultant metabolic derangement, if left untreated, can progress to kidney failure, mental status changes, seizures, arrhythmias, and even death. Diagnosing TLS can be challenging in patients with MM due to its uncommon association and often seen associated renal insufficiency [131]. It is imperative for clinicians to be aware of this complication in MM patients undergoing treatment with novel combinations.…”

Section: Metabolicmentioning

confidence: 99%

What the Intensivists Need to Know About Critically Ill Myeloma Patients

Nair¹,

Patel²

2018

Oncologic Critical Care

View full text Add to dashboard Cite

Multiple myeloma (MM) is a hematological malignancy characterized by an increase in aberrant plasma cells in the bone marrow leading to rising monoclonal protein in serum and urine. With the introduction of novel therapies with manageable side effects, this incurable disease has evolved into a chronic disease with an acceptable quality of life for the majority of patients. Accordingly, management of acute complications is fundamental in reducing the morbidity and mortality in MM. MM emergencies include symptoms and signs related directly to the disease and/or to the treatment; many organs may be involved including, but not limited to, renal, cardiovascular, neurologic, hematologic, and infectious complications. This review will focus on the numerous approaches that are aimed at managing these complications.

show abstract

Management of Tumor Lysis Syndrome in Patients With Multiple Myeloma During Bortezomib Treatment

Abstract: The early identification and intervention of high-risk patients with MM is imperative. Timely and efficient management could decrease TLS incidence rates and improve the efficacy of treatment outcomes.

Cited by 7 publications

References 11 publications

A case of tumor lysis syndrome and acute renal failure associated with elotuzumab treatment in multiple myeloma

A case of tumor lysis syndrome and acute renal failure associated with elotuzumab treatment in multiple myeloma

Ixazomib-associated tumor lysis syndrome in multiple myeloma

What the Intensivists Need to Know About Critically Ill Myeloma Patients

Contact Info

Product

Resources

About