Tumour Lysis Syndrome and Partial Remission Occurring After Administration of a Test Dose of Obinutuzumab

Abstract

Chronic lymphocytic leukaemia (CLL) is one of the most common haematological malignancies worldwide, with an increasing prevalence in the elderly population. Obinutuzumab is a type II anti-CD20 monoclonal antibody which showed superiority over rituximab in combination chemotherapy with chlorambucil for the treatment of CLL in the CLL11 trial (NCT01010061) and is becoming part of standard first line treatment for CLL in the elderly based on its potent efficacy and benign safety profile. We report the case of a chemotherapy naive patient who develop tumour lysis syndrome despite appropriate prophylaxis, and had partial remission of her disease after receiving only the initial test dose of obinutuzumab. LEARNING POINTS• Chemotherapy-induced tumour lysis syndrome is a serious complication that can occur after even a small dose of chemotherapy.• Chronic lymphocytic leukaemia patients with strongly positive CD20 cells can be more sensitive to obinutuzumab chemotherapy.

Laboratory features of tumour lysis syndrome following daratumumab monotherapy in relapsed/refractory multiple myeloma

“…TLS was reported following treatment with elotuzumab, however the picture in this case was complicated by pre‐treatment with lenalidomide and concomitant medications [ 8 ]. In a case of chronic lymphocytic leukaemia (CLL), a single test dose of obinutuzumab led to TLS and rapid tumour reduction [ 9 ].…”

Dysphagia: what we know? A minireview

“…However, Giordano et al, have been reported that in an octogenarian, the only clinical symptoms of generalized tetanus, dysphagia and tremor 7 . It has been reported that isolated bulbar symptoms, as dysphagia, in elderly, may be included in the differential diagnosis 8 . To this regard, the European Society for swallowing disorders-European Union Geriatric Medicine Society describe that dysphagia can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration/pneumonia and increased readmissions, institutionalization and mortality.…”