Tumor lysis syndrome, acute kidney injury and disease-free survival in critically ill patients requiring urgent chemotherapy

Abstract

Background Tumor lysis syndrome (TLS) is a life-threatening complication during the treatment of malignant neoplasia. We sought to describe characteristics and predictors of acute kidney injury (AKI), remission and mortality in high-risk TLS patients. In this retrospective monocentric study, we included all patients with the diagnosis of biological and/or clinical TLS from 2012 to 2018. The primary outcome was the prevalence of AKI during the acute phase of TLS. Secondary outcomes were overall mortality and remission of the underlying malignancy at 1 year. Results Among 153 patients with TLS, 123 (80.4%) patients experienced AKI and 83 (54.2%) required renal replacement therapy. mSOFA score (OR = 1.15, IC 95% [1.02–1.34]), age (OR = 1.05, IC 95% [1.02–1.08]) and male gender (OR = 6.79, IC 95% [2.59–19.44]) were associated with AKI. Rasburicase use (HR = 2.45, IC 95% [1.17–5.15]) was associated with remission of the underlying malignancy at 1 year. Parameters associated with mortality at 1 year were mechanical ventilation (HR = 1.96, IC 95% [1.02–3.78]), vasopressors (HR = 3.13, IC 95% [1.59–6.15]), age (HR = 1.02, IC 95% [1–1.03]), spontaneous TLS (HR = 1.65, IC 95% [1.01–2.69]) and delay of chemotherapy administration (HR = 1.01, IC 95% [1–1.03]). Conclusions AKI is highly prevalent in TLS patients. Rasburicase is associated with better outcomes regarding remission of the underlying malignancy. As rasburicase may be an indirect marker of a high degree of tumor lysis and chemosensitivity, more studies are warranted to confirm the protective role of urate oxidase. Delaying chemotherapy may be deleterious in terms of long-term outcomes.

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

“…Additionally, in accordance with previous studies, TLS following CAR-T therapy showed detrimental effects on patient prognosis, clinical response, PFS and OS. Acute kidney injury (AKI) had high prevalence during the acute phase of TLS and was reported as a major cause of death in TLS with an OR of 10.41 for in-hospital mortality ( 17 – 19 ). In our cohort, TLS related AKI resulted in ICU administration, renal replacement therapy and 30-day modality.…”

Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature

“…Primary tumors were mostly large bulky masses (with a median largest transverse dimension of about 9 cm), commonly located in the lungs, colon, or liver [ 2 , 6 , 20 , 46 , 93 ]. Most patients had been diagnosed with metastatic disease mainly in the liver and/or lungs and had an unfavorable prognosis compared to previous studies on STLS of hematological malignancies [ 94 ]. There was a significantly higher likelihood of STLS-specific death in patients with metastatic disease – especially in those with liver or lungs involvement – compared to those without diagnosis of metastatic disease.…”

Malignancy diseases and kidneys: A nephrologist prospect and updated review

“…[ 73 ] TLS may sometimes resemble sepsis and present with acute respiratory failure, hemodynamic instability, and systemic inflammatory response syndrome. Abdel-Nabey et al [ 78 ] reported that in 153 TLS patients admitted into intensive care, AKI was reported in 82% of the patients.…”

“…It was reported that delayed hyperuricemia treatment might have long-term effects. [ 78 ] Identifying high-risk TLS patients as soon as possible to prevent TLS and TLS-induced AKI is crucial. [ 80 ] The cornerstone of TLS care is hydration and hypouricemic medications (allopurinol and rasburicase).…”