A Case of T-cell Acute Lymphoblastic Leukemia presented with Spontaneous Tumor Lysis Syndrome and Superior Bena Cava Syndrome

ABSTRACT

Acute spontaneous tumor lysis syndrome is a condition resulting from the rapid release of cellular breakdown products into the circulation due to massive cytolysis occurring before start of treatment. It occurs most often in Burkitt's lymphoma and T-cell ALL, both of which have been well described, following cytotoxic chemotherpy and other single agent administrations. However, only a handful of spontaneous acute tumor lysis syndrome cases have recently been reported in the literature. We have recently experienced a case of a T-cell ALL in a 9-year-old girl presented with superior vena cava syndrome(SVC syndrome) and uric acid nephropathy due to acute spontaneous tumor lysis syndrome. On admission, she had marked elevation in serum uric acid, BUN and creatinine. She was given dexamethasone administration as a treatment of SVC syndrome and was supported with allopurinol therapy, hyperhydration and alkalinization of urine. On day 7 following continuous dexamethasone administration, her BUN and creatinine returned to normal and no blast cells was found in peripheral blood. Then, ALL induction chemotherapy (CCG-1882 protocol) was used, resulting in complete remission.