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A 49-year-old man with a structurally normal heart presented to the emergency department with pyelonephritis secondary to extended spectrum beta lactamase Escherichia coli , resulting in both septic shock and an acute kidney injury. He had a background history of a renal transplant for adult

Introduction Involvement of the peritoneum occurs very rarely and is exceptional as an exclusive extranodal presentation of lymphomas. In most cases lymphomas associated with this rare entity are high-grade ones. PL secondary to high-grade nodal lymphoma is more frequent than primary peritoneal lymphoma, and there are only a few cases of the latter described in the literature. Description of the case We present the case of a patient with constitutional syndrome and imaging findings suggestive of peritoneal carcinomatosis who was finally diagnosed with a Diffuse Large B-cell Lymphoma (DLBCL) by an ultrasound-guided core needle biopsy (CNB) of peritoneum. The patient received one polychemotherapy cycle; however tumor lysis syndrome occurred with death of the patient in the following days. This case tries to show the existence of a PL without other radiological findings of lymphoma, a fact that is very exceptionally described in the literature. Discussion The differential diagnosis between PL and others peritoneum diseases such as peritoneal carcinomatosis, malignant primary peritoneal mesotheliomas, tuberculous peritonitis, sarcomatosis, diffuse peritoneal leiomyomatosis or benign splenosis, constitutes a major problem in imaging techniques. An exhaustive analysis of the radiological characteristics as well as a clinical-analytical context allows the differential diagnosis against peritoneal carcinomatosis and the rest of the entities previously referred although the final diagnosis will always be a biopsy. Conclusion PL usually manifests as an aggressive histological subtype of high-grade lymphomas leading to a rapid progression and deterioration of the patient. It is crucial for the radiologist and the clinician to be aware of this rare entity providing the earliest possible diagnosis and optimal treatment to prolong the patient's life.

Disseminated carcinomatosis of the bone marrow (DCBM) is often accompanied by disseminated intravascular coagulation (DIC) and has a poor prognosis. DCBM develops most frequently in gastric cancer and is rarely associated with intrahepatic cholangiocarcinoma. A 41-year-old man was incidentally found to have DIC on his regular visit for ulcerative colitis and was diagnosed with DCBM with intrahepatic cholangiocarcinoma. He received intensive care, including chemotherapy, but died suddenly from hyperkalemia, possibly due to tumor lysis syndrome (TLS). The autopsy showed the periductal infiltrating type of intrahepatic cholangiocarcinoma and tumor necrosis, possibly due to chemotherapy, indicating the effectiveness of chemotherapy for DCBM with intrahepatic cholangiocarcinoma.

Tumor lysis syndrome (TLS) is a commonly observed oncological emergency that requires prompt diagnosis and treatment. Rasburicase is a recombinant urate oxidase endorsed in TLS for the treatment of hyperuricemia. The effect of single-dose 7.5 mg rasburicase at longer follow-ups was not widely investigated.Eighty-two patients included in the study with clinical TLS and laboratory TLS. The primary endpoint was the normalization of uric acid (6mg/dL) within 24 hours of rasburicase administration, which was described as treatment success. The secondary endpoint was defined as having sustained response at the first week. The third endpoint was defined as the reaching the baseline renal function before TLS.We found that the use of a 7.5 mg dose of rasburicase controlled uric acid in 74 of 82 (90,2%) patients at the 24th hour. In the first week, uric acid remained at normal levels in 69 of 82 (84,1%) patients. At 24 hours, the TLS risk group was the only predictor for failing uric acid normalization; at the end of the first week, no predictive factor was identified for failing uric acid normalization.Rasburicase at 7.5 mg dose is an important agent for controlling laboratory and clinical TLS at 24 hours and extending its effect to the first week.

Highlights • Radiotherapy can trigger cytokine release syndrome and tumor lysis syndrome in association with chemotherapy drugs. • Extreme caution must be given when irradiating large tumor volumes at high risk of tumor lysis. • Evidence of cytokine release following radiotherapy unveils the systemic interactions of radiotherapy with the immune system., We present the case of a 53-year-old woman treated with analgesic radiotherapy for a multiple myeloma bone lesion of the forearm. After a first fraction of 5 Gray (Gy), she presented with an acute respiratory syndrome with fever a few hours after the treatment. The same symptoms occurred after the second fraction 3 days later. The patient recovered quickly thanks to intravenous hydration and suspension of the radiotherapy. Biological tests revealed a tumor lysis syndrome. We concluded that the clinical symptoms could be defined as cytokine release syndrome. This is the second time in the literature that cytokine release syndrome has been described following radiotherapy. First, we synthesize TLS and radiotherapy to determine how radiotherapy could be a trigger associated with other well-known factors. Furthermore, we discuss radiotherapy and cytokine release syndrome. Summary We present the case of a woman treated with analgesic radiotherapy for a multiple myeloma bone lesion. Following the first and the second treatment fraction, the patient presented with an acute respiratory syndrome with fever and biological tests revealed a tumor lysis syndrome. We concluded that the clinical symptoms could be defined as cytokine release syndrome. Furthermore, we discuss how radiotherapy could be a trigger of cytokine release syndrome and tumor lysis syndrome in association with chemotherapy drugs.

CAR-T cells are an innovative treatment for an increasing number of patients, particularly since the extension of their indication to mantle lymphoma and multiple myeloma. Several complications of CAR T-cell therapy, that were first described as exceptional, have now been reported in series of patients, since its first clinical use in 2011. Among them, cardiac complications, delayed cytopenias, acute and chronic Graft versus Host Disease, and tumoral lysis syndrome are recognized as specific potent complications following CAR T-cells infusion. During the twelfth edition of practice harmonization workshops of the Francophone society of bone marrow transplantation and cellular therapy (SFGM-TC), a working group focused its work on the management of these complications with focuses the epidemiology, the physiopathology and the risk factors of these 4 side effects. Our recommendations apply to commercial CAR-T cells, in order to guide strategies for the management of complications associated with this new therapeutic approach.

Tumor lysis syndrome (TLS) is an oncologic emergency most frequently associated with initial treatment of hematologic malignancies and high-tumor burden solid tumors such as small-cell lung cancer (SCLC). Most often, TLS is associated with cytotoxic chemotherapy. In the treatment of SCLC, a paradigm shift has taken place in which immunotherapy is often added to chemotherapy for extensive-stage disease in the frontline setting or as monotherapy in the relapsed setting. Nivolumab is a programmed death 1 receptor blocking antibody previously FDA indicated for the treatment of metastatic SCLC with progression after platinum-based chemotherapy and at least one other line of therapy. Nivolumab, like all immune checkpoint inhibitor therapies, is associated with immune-mediated adverse reactions; however, there are few reported cases of nivolumab-induced TLS. We present a case of nivolumab-induced TLS following a single infusion. An 86-year-old female with a history of widely metastatic SCLC with metastasis to the liver, bone, and lymph nodes presented to the hospital following a fall due to weakness, dizziness, slurred speech, nausea, vomiting, and abdominal pain occurring 6 days after receiving her first nivolumab infusion. After extensive evaluation, the patient was diagnosed with TLS with hyperkalemia, acute renal failure, hyperphosphatemia, and hypocalcemia. She was treated aggressively with intravenous fluids, rasburicase, and sodium polystyrene sulfate (Kayexalate®), which resulted in rapid improvement of her electrolytes and renal function. However, despite correction of electrolytes and overall symptomatic improvement, over the course of several days, the patient’s condition rapidly deteriorated with increasing dyspnea, lethargy, confusion, and eventually death. TLS following nivolumab is exceedingly rare. This report highlights the potential risk of development of TLS with checkpoint inhibitor therapy.

Ibrutinib plus venetoclax, given with an ibrutinib lead-in, has shown encouraging clinical activity in early phase studies in mantle cell lymphoma (MCL). The ongoing phase 3 SYMPATICO study evaluates the safety and efficacy of concurrently administered, once-daily, all-oral ibrutinib plus venetoclax in patients with relapsed/refractory MCL. A safety run-in (SRI) cohort was conducted to inform whether an ibrutinib lead-in should be implemented for the randomized portion. Patients received concurrent ibrutinib 560 mg continuously plus venetoclax in a 5-week ramp-up to venetoclax 400 mg for up to 2 years. The primary endpoint was occurrence of tumor lysis syndrome (TLS) and dose-limiting toxicities (DLTs). The SRI cohort enrolled 21 patients; six and 15 were in low- or increased-risk categories for TLS, respectively. During the 5-week venetoclax ramp-up, three patients had DLTs, and one patient at increased risk for TLS had a laboratory TLS; no additional TLS events occurred during follow-up. With a median follow-up of 31 months, the overall response rate was 81% (17/21); 62% (13/21) of patients had a complete response. SRI data informed that the randomized portion should proceed with concurrent ibrutinib plus venetoclax, with no ibrutinib lead-in. Ibrutinib plus venetoclax demonstrated promising efficacy; no new safety signals were observed.Trial registration: ClinicalTrials.gov, NCT03112174. Registered 13 April 2017, https://clinicaltrials.gov/ct2/show/NCT03112174.

Tumor lysis syndrome (TLS) can be a life-threatening complication that occurs following the onset of chemotherapy treatment, most commonly in association with high-grade lymphoproliferative pathologies such as acute lymphoblastic leukemia and Burkitt lymphoma. The massive cell lysis caused by cytotoxic therapy leads to the rapid release in the blood of intracelullary products and the onset of severe metabolic and electrolytic complications (hyperkalemia, hyperphosphatemia, hypocalcemia and hyperuricemia) upto the acute renal failure. This article describes the incidence and pathophysiological basis of TLS, focusing on the new therapeutic strategies implemented over the last few years, especially with regard to the treatment of hyperuricemia. In particular, it highlights the characteristics of a recent drug, Rasburicase, as a safe and effective alternative, compared to traditional allopurinol therapy, for prophylaxis and treatment of children with hyperuricemia induced by chemotherapy.

We want to know the causes of AKI in oncology patients, including disease-related complications and the nephrotoxicity of chemotherapy drugs, in order to provide more useful clinical information. In this review, an electronic search of the English language literature was performed in the database PubMed, with the results enriched by manual searches and citation mining, factors investigated in the selected articles included acute kidney injury, oncology, chemotherapy, anticancer drug, antitumor drug. According to the searched articles, we summarized the causes (including pre-renal, intrinsic renal, and post-renal lesion) of AKI in cancer patients and the corresponding management measures. Among the pre-renal factors we mainly described hypercalcemia, hematopoietic cell transplantation, post-renal factors we mainly described hemorrhagic cystitis, and intrinsic renal factors we mainly described thrombotic microangiopathy, chemotherapeutics, tumor lysis syndrome, cast nephropathy, in which the emphasis was on chemotherapy drug associated AKI and its treatment. AKI is not uncommon in cancer patients, and has diverse causes and negative outcomes. Both nephrologists and oncologists need to be aware of the unique reasons of AKI in this population and its optimal management.

Tumor lysis syndrome (TLS) is the most common hematologic emergency encountered during the treatment of high-grade malignancies. While it can lead to death, the prognosis is typically excellent if caught early on in the course. Risk stratification prior to treatment initiation is paramount in deciding the utility of prophylaxis and ultimately in reducing morbidity and mortality. The following case describes the development of TLS in a patient categorized as low risk and highlights the need for further elucidation of a unified risk stratification system.

Treatment‐related complications contribute substantially to morbidity and mortality in acute myeloid leukemia (AML) patients undergoing induction chemotherapy. Although AML patients are susceptible to fluid overload (FO) (e.g., in the context of chemotherapy protocols, during sepsis treatment or to prevent tumor lysis syndrome), little attention has been paid to its role in AML patients undergoing induction chemotherapy. AML patients receiving induction chemotherapy between 2014 and 2019 were included in this study. FO was defined as ≥5% weight gain on day 7 of induction chemotherapy compared to baseline weight determined on the day of admission. We found FO in 23 (12%) of 187 AML patients undergoing induction chemotherapy. Application of >100 ml crystalloid fluids/kg body weight until day 7 of induction chemotherapy was identified as an independent risk factor for FO. AML patients with FO suffered from a significantly increased 90-day mortality rate and FO was demonstrated as an independent risk factor for 90-day mortality. Our data suggests an individualized, weight-adjusted calculation of crystalloid fluids in order to prevent FO-related morbidity and mortality in AML patients during induction chemotherapy. Prospective trials are required to determine the adequate fluid management in this patient population.

Introduction. This article, using a clinical case as an example, reflects the problem of the development of tumor lysis syndrome (TLS). The most common cause of SLO development is antitumor treatment: radiation therapy, radiofrequency ablation, vascular embolization, the use of monoclonal antibodies, high-dose chemotherapy with transplantation of stasis from peripheral blood. This disorder leads to the development of metabolic, hemodynamic, respiratory and renal disorders. The TLS distinguished by high mortality rates, from 17% to 70%.Materials and methods. Presented a clinical case of patient, 30 years old - observation of successful treatment of TLS of the III degree of clinical course according to Cairo-Bishop, in the conditions of the State Budgetary Healthcare Institution «Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine», in the conditions of the intensive care unit and intensive care with the use of renal replacement therapy on the Prismaflex device.Results and discussion. When the patient applied to the State Budgetary Healthcare Institution «Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine», the diagnosis made — Non-Hodgkin lymphoma with a diffuse type of growth of a high degree of malignancy. Revealed the defeat of the lymph nodes, parietal pleura, right hemithorax, atelectasis of the middle lobe of the right lung with air bronchography, hydrothorax on both sides, hydropericardium, free fluid in the pelvic cavity, phlebolitis of the parametric tissue, degenerative-dystrophic changes in the spine. On the first day of hospitalization, antibacterial and pain relief therapy started, and nutritional disturbances were corrected. After the pre-phase chemotherapy (cyclophosphamide, vincristine), the patient's condition worsened, she was transferred to the intensive care unit. Where was the treatment carried out: convulsive syndrome, respiratory failure, acute renal failure, bilateral pneumonia, PE. Against the background of this therapy, special treatment continued - 2 cycles of chemotherapy. After the patient transferred to spontaneous breathing and the indices of blood slags and potassium were normalized, she was transferred to the antitumor therapy department to continue special treatment. Conclusion. Our algorithm for the treatment of SLO led to positive dynamics and the possibility of carrying out special antitumor therapy for this patient.

Multiple myeloma (MM) remains an incurable disease despite incorporation of novel agents. Venetoclax, a B-cell lymphoma 2 (BCL-2) inhibitor is approved for some hematologic malignancies but not yet for MM, although clinical trials have shown efficacy in patients with MM, particularly those harboring t(11;14). We reviewed the medical records of relapsed and/or refractory MM patients to study the efficacy and safety of venetoclax used outside of clinical trials at Mayo Clinic between December, 2016 and March, 2019. The data cut-off date was August 06, 2020. We identified 56 patients of whom 42 (75%) harbored t(11;14). The median number of prior therapies was six (range 1-15) and 14% of patients had received ≥10 prior lines of therapy. Fifty-three (95%) patients were refractory to an immunomodulatory drug and proteasome inhibitor. Venetoclax was used as monotherapy or doublet, in combination with dexamethasone in 55% (n = 31) and a triplet or quadruplet in 45% of patients. No patient experienced tumor lysis syndrome. Overall response rate in 52 evaluable patients was 44%. The median time to best response was 2 months and median duration of response was 13.6 months. The median PFS for the entire cohort was 5.8 (95% CI 4.9-10.3) months and median OS was 28.4 (95% CI 14.6-not reached) months. The presence of t(11;14) was associated with improved PFS (median 9.7 months vs. 4.2 months, p = 0.019) and OS (median not reached vs. 10.8 9 months, p = 0.015). Venetoclax demonstrates encouraging activity in heavily-treated patients with relapsed/refractory MM, particularly the t(11;14) patient-population.

Background B-cell tumors and plasma cell malignancies have been identified in persons living with the human immunodeficiency virus (PLHIV). The literature review has revealed numerous reports of solitary plasmacytomas with metastasis in PLHIV. Case report A young patient with no prior medical or surgical history presented with tumor lysis syndrome secondary to metastatic plasma cell Epstein-Baer virus (EBV) related malignancy with peritoneal carcinomatosis. The history and clinical picture promptly led to the diagnosis of HIV. The subsequent hospital course was dismal, and lifespan was cut short by multi-organ failure. Conclusion This case is being reported to highlight the suspicion of HIV in patients presenting acutely with aggressive plasma cell malignancies.

1. Amanda J. Clark, MD* 2. Lauren Matevish, MD† 3. Marta Hernanz-Schulman, MD‡ 4. Emily F. Mason, MD, PhD§ 5. Tracy E. Hunley, MD¶ 1. *Division of Pediatric Nephrology, Boston Children’s Hospital, Boston, MA 2. †Vanderbilt University School of Medicine, Nashville, TN 3. ‡Division of Diagnostic Imaging, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN 4. §Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 5. ¶Division of Pediatric Nephrology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN A 13-year-old girl presents to the pediatric clinic with complaints of malaise, progressive nausea, emesis, and poor oral intake since removal of her wisdom teeth 1 month earlier. In that month she completed a course of clindamycin to treat a suspected postoperative oral infection. Review of systems revealed a 10-lb unintentional weight loss, intermittent joint pain, and decreased urine output. She denies any fevers. Vital signs are normal other than blood pressure of 130/72 mm Hg and pulse of 121 beats/min. Physical examination shows a tired-appearing but polite young lady with a slightly enlarged, asymmetrical thyroid and otherwise normal examination findings. A complete blood cell count shows a hemoglobin level of 11.6 g/dL (116 g/L), a platelet count of 0.153 × 103/mcL (0.153 × 109/L), and a white blood cell count of 5.3/µL (0.01 × 109/L) with a normal differential cell count. Thyrotropin and free T4 levels are normal. Her sedimentation rate is 43 mm/hr. A complete metabolic panel reveals normal sodium, potassium, chloride, carbon dioxide, albumin, total protein, and calcium levels. Her creatinine level is elevated to 2.29 mg/dL (202.44 µmol/L), blood urea nitrogen level is 36 mg/dL (12.9 mmol/L), total bilirubin level is 1.1 mg/dL (18.8 µmol/L), aspartate aminotransferase level is 53 U/L (0.89 µkat/L), and alanine aminotransferase level is 37 U/L (0.62 µkat/L). The urine pregnancy test result is negative. Dipstick urinalysis reveals yellow urine, specific gravity of 1.010, pH 5.5, moderate blood, trace protein, positive nitrites, negative leukocyte esterase, and small bilirubin. Urine microscopy is striking for numerous uric acid crystals (Figs 1 and 2). Additional serum testing and imaging lead to the diagnosis. Figure 1. Urine microscopy at 10× magnification showing the striking presence of crystalluria. Figure 2. Urine microscopy at 40× magnification again showing striking crystalluria with several morphologies of uric acid crystal, including diamonds (thin arrow), rhomboid …

Objective and background: Tumor lysis syndrome (TLS) is a life-threatening emergency and demands emergency care of effective outcome with minimal or no side effects. The Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate used for the management of TLS. This study was designed to evaluate the Role of Hypouricemic agents by analyzing TLS development rate, control of uric acid, and Creatinine levels. Methods: An extensive electronic data search was conducted by using all leading scientific databases. Twenty-six studies were selected to conduct this study, as per the inclusion criteria. Results: The Odd ratio of TLS development rate was 4.06, 1.24, and 1.49 by Rusbricase, Allopurinol & Febuxostate administration respectively. 95% confidence interval was reported by selected studies against TLS development rate, Uric acid, and Creatinine levels by administrating Rusbricase, Allopurinol & Febuxostate. Conclusion: All Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate, are effective to manage Tumor lysis Syndrome. However, a suitable and most effective intervention dose needs to identify with better efficacy and minimal side effects both in Adults and Children.

Uric acid drives acute kidney injury in tumor lysis syndrome (TLS). This study investigated the relationship between uric acid and changes in estimated glomerular filtration rate (eGFR) in adults at risk for TLS. Linear regression was used to evaluate the relationship between uric acid area under the curve (AUC) and percent change in eGFR from baseline at hospital dismissal, 1 and 3 months. In 210 included participants, each 100 mg*hour/dL increase in 24 h AUC was associated with an average decline in eGFR at hospital dismissal of 9% (95%CI 3, 15) in univariate analysis. Each 100 mg*hour/dL increase in 24 h AUC was independently associated with an average decline in eGFR of 8% (95%CI 2, 13) at 1 month after dismissal. Additional research is needed to confirm these findings and determine whether treatments that reduce overall uric acid exposure improve kidney outcomes. Preserving kidney health could favorably impact cancer treatment eligibility, tolerability, and outcomes.

Importance Burkitt lymphoma with bone marrow involvement and Burkitt leukemia behave aggressively. Thus far, there are limited data concerning survival and toxicity in Chinese children with Burkitt lymphoma or Burkitt leukemia who have undergone treatment with the non‐Hodgkin’s lymphoma Berlin‐Frankfurt‐Münster‐90/95 (NHL‐BFM‐90/95) protocol. Objective To analyze outcomes and toxicity in pediatric patients who exhibit Burkitt lymphoma with bone marrow involvement or Burkitt leukemia following treatment with the NHL‐BFM‐90/95 protocol. Methods Patients aged

Chronic lymphocytic leukemia (CLL) is a progressive disease with an indolent course, and tumor lysis syndrome (TLS) is rarely seen in CLL. Ibrutinib is a novel bruton kinase (BTK) inhibitor increasingly used in CLL treatment. Ibrutinib has significant side effects such as atrial fibrillation, bleeding, diarrhea, and infections. However, TLS is reported rarely with ibrutinib treatment. This report focuses on a 69-year-old female patient diagnosed with relapsed CLL who developed grade 4 TLS after ibrutinib monotherapy. The patient developed TLS on the third day of ibrutinib treatment necessitating discontinuation of the treatment and initiation of hemodialysis and supportive care. Ibrutinib treatment was re-initiated at a daily dose of 140 mg therapy after an interval of seven days, and then any additional side effect was not seen. Tumor lysis syndrome secondary to ibrutinib has been reported in an increasing number of cases. There is currently no information on managing adverse effects of TLS attributed to ibrutinib. Consequently, ibrutinib treatment of this patient was not terminated, and restarted after a short interval. It must not be forgotten that TLS secondary to ibrutinib treatment may be rarely seen, and can be life-threatening. Treatment with ibrutinib should be initiated in consideration of this side effect, and the development of complication of TLS may not necessitate discontinuation of ibrutinib treatment.

Background: Axicabtagen Ciloleucel (axi-cel) is approved in Europe for the treatment of adults with R/R large B-cell lymphoma (LBCL), primary mediastinal B-cell lymphoma (PMBCL) and transformed follicular lymphoma (tFL). In Spain, nationwide CAR-T administration requests are reviewed centrally within the Ministry of Health. We analyzed the real-world outcomes of patients treated with axicel under the commercial label in Spanish centers. Methods: Six designated centers for commercial CAR-T administration collected data on behalf of GETH-GELTAMO. Data were collected retrospectively from consecutive patients in whom apheresis was performed for axi-cel treatment from Febrruary-2019 to November-2020. CRS and ICANS were graded with the ASTCT consensus criteria. Response was assessed according to the Lugano criteria. Results: 106 patients with R/R lymphoma underwent apheresis for axi-cel. At data cutoff, 92 (87%) received infusion. The reasons for not undergoing infusion were progression-related death in 12 (86%), tumor lysis syndrome in 1 (7%) and complete response after bridging therapy in 1 (7%). Of note, 14 patients were conditioned and infused during the peak of COVID-19 epidemic in Spain (March-April 2020). Median time from Ministry approval to infusion was 54 days. Histology consisted of 74% DLBCL with 11% tFL, and 15% PMBCL. Disease status at lymphodepletion was PD in 69%, SD in 22% and PR in 9%. All patients received lymphodepletion. Median time from leukapheresis to start of lymphodepletion was 34 days. Median time from leukapheresis to infusion was 39 days. Median hospitalization period was 21 days. Any grade of CRS occurred in 86% of pts (18% grade 2, 6.5% grades 3-4). Tocilizumab was used in 58% of patients who developed CRS, corticosteroids in 19%. ICANS was diagnosed in 42.5% of pts (10% grade 2, 15% grade 3-4). Treatment for ICANS included corticosteroids in 78%, tocilizumab in 31%, siltuximab in 15%, and anakinra in 21%. ICU admission was needed in 20 patients (22%). 4 patients died in the context of ICANS, 1 due to CRS, and 1 due to infection. Of 80 patients evaluable and restaged at day 30, ORR was 78% with 40% CR, 38% PR, 11% PD and 11% SD or indeterminate. Of 58 patients evaluable at day 100, 66% had ongoing response (CR 48%, PR 18%). Of 23 patients evaluable at day 180, 65% presented CR. Of 39 patients who showed PR/SD at day 30, 9 (23%) converted to CR. After a median follow-up of 6.3 months, EFS and OS were 55.5% and 78%, respectively in the infused population, with an estimated median EFS and OS of 13.1 and 7.3 months. In the intention-to-treat analysis for all patients who underwent apheresis, median estimated OS and EFS were 12.3 (95%CI 8.9-15.7) and 6.6 months (95%CI 4.6-8.5), respectively (Figure 1). Conclusions: This Spanish multicenter retrospective analysis shows encouraging results of axi-cell treatment in patients with R/R aggressive B-cell lymphoma in the real-world setting. Significant toxicity events were less frequent than those reported in the pivotal trial, however events of mortality associated to toxicity occurred. With a limited follow-up time, response outcomes are favorable.

Tumor lysis syndrome is an oncometabolic emergency caused by rapid cell death. Tumor lysis syndrome can occur spontaneously or as a result of tumor-targeted therapy. The aim of this study is to review the literature on Tumor Lysis Syndrome and nursing care.The cancer patient should be closely monitored regarding the laboratory and clinical symptoms of tumor lysis syndrome, and preventive interventions such as adequate hydration, use of phosphate binders, uric acid-lowering treatment and reduction of the patient's potassium intake are important in high-risk patients. Oncology and intensive care nurses, who are health professionals, should classify each hospitalized cancer patient and especially those receiving chemotherapy in terms of tumor lysis syndrome risk and provide supportive care to the cancer patient., Tümör lizis sendromu, hızlı hücre ölümünden kaynaklanan onkometabolik acil bir durumdur. Tümör lizis sendromu, tümör hedefli tedavinin bir sonucu olarak veya kendiliğinden ortaya çıkabilmektedir. Bu çalışmanın amacı tümör lizis sendromu ve hemşirelik bakımı ile ilgili literatür bilgisinin derlenmesidir. Tümör lizis sendromunun laboratuvar ve klinik belirti bulguları ile ilgili olarak kanser hastası yakından izlenmeli, yüksek risk grubundaki hastalara yeterli hidrasyon, fosfat bağlayıcıların kullanımı, ürik asit düşürücü tedavi ve hastanın potasyum alımının azaltılması gibi önleyici girişimlerin uygulanması önemlidir. Sağlık profesyoneli olan onkoloji ve yoğun bakım hemşireleri, hastanede yatan her kanser hastasını ve özellikle kemoterapi görenleri tümör lizis sendromu riski açısından sınıflandırarak kanser hastasına destekleyici bakım vermelidir.

Oncological emergencies present in a multitude of manners-structural, metabolic, hematologic, etc. affecting multiple systems, often. Urgent institution of therapy is often required for a successful outcome. Occasionally, the treatment of one emergency can initiate a related or unrelated emergency, necessitating management of all the complications simultaneously. Superior vena cava obstruction (SVCO) is a medical emergency and most often manifests in patients with a malignant disease process requiring immediate diagnostic evaluation and therapy due to its’ life threatening presentation. The management of the SVCO is usually with chemotherapy, radiotherapy or intervention. In cases of large tumor burden, management of SVCO can trigger other complications. Tumor lysis syndrome is an oncologic emergency, which is characterized by a massive release of intracellular potassium, phosphate, and nucleic acid metabolites into the systemic circulation, which can be life-threatening. We present the case of a T-cell acute lymphoblastic leukemia with superior vena cava syndrome, developing tumor lysis syndrome on instituting definitive chemotherapy in a young patient. Doi: 10.28991/SciMedJ-2021-0301-6 Full Text: PDF

Összefoglaló. A Bruton-féle tirozin-kinázt gátló ibrutinib és a B-sejtes lymphoma-2-t gátló venetoklax a krónikus lymphoid leukaemia (CLL) kezelésének egyre korábbi vonalában alkalmazható, és ezek mellett a progressziómentes túlélés növekedése figyelhető meg. A célzott kismolekulákkal végzett kezelés nemcsak a CLL lefolyását, de a betegek gondozását is alapvetően megváltoztatta. A tartósan adagolt orális szerek mellett a betegek nagyobb valószínűséggel jelennek meg a panaszaiknak megfelelő szakrendeléseken. Az új típusú szerek hatásai és mellékhatásai mellett az alapvető gyógyszer-interakciókra is fel kell hívni a figyelmet. Kiemelt fontosságú az ibrutinib hypertoniát provokáló hatása, illetve a 6–16%-ban megjelenő pitvarfibrilláció. Ez utóbbi ellátását a gyógyszer-interakciókon túl az ibrutinib vérzékenységet okozó hatása is nehezíti. A CLL-lel, illetve annak kezelésével kapcsolatos ismeretek a másodlagos daganatok, néhány gastrointestinalis és bőrgyógyászati betegség megközelítése szempontjából is fontosak. A venetoklax mellett potenciálisan kialakuló tumorlízis-szindróma alkalmanként a nefrológusok bevonását igényli. A betegek gondozása, megfelelő szakszerű ellátása és a betegutak optimalizálása érdekében a háziorvosok, a sürgősségi ellátók és az egyéb szakellátó helyek szoros együttműködése szükséges szakorvosi konzultáció keretei között. Orv Hetil. 2021; 162(9): 336–343. Summary. Chronic lymphocytic leukemia (CLL) is ubiquitously treated with novel agents. The Bruton’s tyrosine kinase inhibitor ibrutinib and the B-cell lymphoma 2 inhibitor venetoclax can be used increasingly in earlier lines of treatment with improved progression-free survival. Treatment with targeted small molecules fundamentally changed not only the course of CLL but also the care of patients. With the administration of long-term oral medications, patients are more likely to show up at specialist clinics that match their complaints. In addition to the effects and side effects of the new drugs, attention should also be drawn to basic drug interactions. The effect of ibrutinib on blood pressure and the ability to provoke atrial fibrillation in 6–16% of cases are of paramount importance. In addition to drug interactions, the treatment of the latter is also complicated by the hemorrhagic effect of ibrutinib. Knowledge on CLL and its treatment is also important in the approach to secondary tumors, some gastrointestinal and dermatological diseases. The potential for tumor lysis syndrome of venetoclax requires close collaboration with nephrologists. In order to provide appropriate professional care and optimize patient pathways, close co-operation between GPs, emergency care providers and other specialist care facilities is required within the framework of professional consultation. Orv Hetil. 2021; 162(9): 336–343.

Background Tumor lysis syndrome (TLS) is a life‐threatening oncologic emergency associated with fatal complications including arrhythmia. The epidemiology and mortality outcomes of arrhythmia in TLS are scarcely studied in the literature. Methods We used the National Inpatient Sample (NIS) to study the prevalence and outcome of arrhythmia in patients hospitalized with TLS (ICD‐9 code 277.88) from 2009 to 2014. Baseline characteristics, burden of arrhythmia, and pertinent outcomes were analyzed. Multivariable regression analysis was performed to identify the impact of underlying malignancy in predicting TLS‐related mortality. Results A total of 9034 cases of arrhythmia among 37 861 TLS patients were identified. More than half of the arrhythmia cases (67%) were found among white old (>65) males admitted to large bed size and urban teaching hospitals. Arrhythmic cohort showed higher frequency of comorbidities such as fluid‐electrolyte disturbances, hypertension, congestive heart failure, renal failure, dyslipidemia, diabetes, pulmonary circulatory disorders, chronic pulmonary disease, coagulopathy, and deficiency anemia. The most common malignancies were leukemia, lymphoma, metastatic tumor, and solid tumor without metastasis. We found significantly higher odds of in‐hospital mortality among patients with TLS compared to general inpatient population on unadjusted (OR 9.69, 95% CI: 9.27‐10.13, P, A total of 23.9% of (n = 9034) encounters with arrhythmia were identified, out of 37 861 TLS‐related hospitalizations. The trends in the prevalence of arrhythmia were stable with rates ranging from 19.8% to 25.8%, with the highest frequency recorded in 2014 (25.8%) (Figure 1A). Atrial fibrillation (13.6%) was the most common arrhythmia followed by ventricular tachycardia in 2.6% of patients (Figure 1B).

Objective Management of hyperuricemia is crucial to controlling tumor lysis syndrome (TLS) during cancer therapy. Urate oxidase (UOX) that catalyzes the enzymatic oxidation of uric acid into allantoin, is effective in lowering plasma uric acid levels and controlling hyperuricemia. Recently, we developed a new recombinant conjugate variant of UOX therapeutic drug using PASylation technology. This study was designed to evaluate the stability, plasma half-life and immunogencity of PASylated UOX. Methods A recombinant variant of PASylated UOX from the Aspergillus flavus was manufactured using bioinformatics and experimental techniques. Ex vivo evaluation of stability of PASylated UOX was done in 50% human serum. For half-life test, recombinant PASylated UOX and rasburicase were administered at 1.5 mg/kg to 10 rats in two different groups and samples were collected after injection Production of antibodies against PASylated drug was also assayed. Results Residual activity of PASylated UOX in 50% human serum was higher than rasburicase and native UOX. Stability of PASylated UOX at 25°C and 37°C was also higher than rasburicase and native UOX. The PASylated half-life was ~32.1 hours, whereas half-life for rasburicase and native UOX was ~25.1 and ~22.8 hours, respectively. In immunogenicity examination, there is 33% and 36% decrease in the absorbance of native UOX and rasburicase, respectively when compared with that of PASylated UOX. Conclusion Our data confirmed the efficacy and stability of PASylated UOX in comparison to the rasburicase. In summary, the results indicated that PASylated UOX drug is effective at lowering plasma uric acid levels with prolonged plasma half-life and decreased cost. .

Background The risk of injury to the kidney can be significantly exacerbated by the presence of tumors and the effects of related treatments. Kidney injury associated with cancer is common in multiple myeloma, tumor lysis syndrome, hematopoietic stem cell therapy, and chemotherapy. Cancer patients are at increased risk of infection, sepsis, tumor lysis syndrome, drug-related toxicity, and other comorbidities, leading to a significantly increased risk of acute kidney injury (AKI). This study retrospectively analyzed the clinical data of AKI in cancer patients and explored the predictive value of Cystatin C (CysC) in the prognosis of cancer patients with AKI. Methods Cancer patients attending the Fifth People's Hospital of Shenyang from April 2014 to March 2019 were enrolled according to inclusion and exclusion criteria. Cancer patients with AKI were divided into two groups according to the changes in renal function during the follow-up period: a renal function recovery group and a nonrecovery group. The differences in baseline data of the two groups were compared. Logistic univariate and multivariate regression analyses were conducted to determine the risk of renal function failure. Results A total of 3,127 cases were included. Among them, 659 cases (21.1%) had AKI, and 2,468 cases had no AKI. Among the 659 AKI patients, 473 (71.8%) patients' renal function recovered, while 186 (28.2%) did not. Logistic univariate and multivariate regression analyses indicated that age [odds ratio (OR) =1.133, 95% confidence interval (CI): 1.064-1.219], diabetes (OR =1.226, 95% CI: 1.093-1.385), chronic kidney disease (CKD) (OR =1.347, 95% CI: 1.108-1.624), hematological malignancies (OR =1.174, 95% CI: 1.063-1.311), chemotherapy (OR =1.119, 95% CI: 1.055-1.304), systolic blood pressure (OR =1.108, 95% CI: 1.062-1.267), serum creatinine (Scr) (OR =1.262, 95% CI: 1.105-1.446), and CysC (OR =1.416, 95% CI: 1.251-1.739) were related to the failure of renal function to recover after AKI. Conclusions Baseline CysC level is associated with the occurrence of AKI in cancer patients and a failure to recover renal function during follow-up.

Prognosis in patients with post allogeneic HCT-early relapse of acute myeloid leukemia (

Prostate cancer can masquerade as just normocytic anemia and thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), or tumor lysis syndrome (TLS). We are reporting an intriguing case of metastatic prostate cancer which remained undiagnosed until the patient showed signs of tumor lysis syndrome (TLS), leading to urate nephropathy requiring urgent hemodialysis. Tumor lysis syndrome is an oncological emergency but an exceedingly rare complication in non-hematological malignancies, including prostate cancer. It is challenging to recognize features of TLS in a case such as this with an unknown diagnosis. In the case of an established diagnosis of malignancy, however, checking baseline renal function, uric acid, lactate dehydrogenase (LDH), potassium, and phosphate to monitor for TLS as well as considering urate lowering therapy can help prevent adverse outcomes.

Pediatric oncology and hematopoietic cell transplant (HCT) patients are susceptible to both acute kidney injury (AKI) and chronic kidney disease (CKD). The etiologies of AKI vary but include tumor infiltration, radiation, drug-induced toxicity, and fluid and electrolyte abnormalities including tumor lysis syndrome. HCT patients can also have additional complications such as sinusoidal obstructive syndrome, graft-versus-host disease, or thrombotic microangiopathy. For patients with severe AKI requiring dialysis, multiple modalities can be used successfully, although continuous kidney replacement therapy (CKRT) is often the principal modality for critically ill patients. While increasing numbers of pediatric cancer and HCT patients are now surviving long term, they remain at risk for a number of chronic medical conditions, including CKD. Certain high-risk patients, due to underlying risk factors or treatment-related complications, eventually develop kidney failure and may require kidney replacement therapies. Management of co-morbidities and complications associated with kidney failure, including use of erythropoietin for anemia and potential need for ongoing cancer-related treatment while on dialysis, is an additional consideration in this patient population. Kidney transplantation can be successfully performed in pediatric cancer survivors, although additional features such as specific cancer diagnosis and duration of remission should be considered.

Tumor lysis syndrome (TLS) is an oncologic emergency caused by release of intracellular tumor components due to massive tumor lysis and is rare in patients with hepatocellular carcinoma (HCC). We describe a case of TLS with rupture of HCC induced by lenvatinib in a patient with advanced HCC. A 72-year-old man who presented with right upper abdominal pain was diagnosed as having advanced HCC with a high tumor burden by contrast-enhanced computed tomography and percutaneous hepatic tumor biopsy. He was started on lenvatinib 12 mg once daily when his tumor progressed despite one-shot hepatic arterial infusion chemotherapy. On day 2 of treatment with lenvatinib, he developed severe upper abdominal pain and was diagnosed as having TLS with HCC rupture by laboratory tests and contrast-enhanced computed tomography. Urgent treatment with transarterial embolization, hemodialysis, and blood transfusion therapy was successful. The patient was then restarted on oral lenvatinib at a reduced dose without recurrence of TLS. TLS is a rare potential complication of lenvatinib in patients with advanced HCC and a high tumor burden.