Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B-NHL: a Children's Oncology Group Report.

Laboratory (LTLS) and clinical (CTLS) tumour lysis syndrome (TLS) are frequent complications in newly diagnosed children with advanced mature B cell non-Hodgkin lymphoma (B-NHL). Rasburicase, compared to allopurinol, results in more rapid reduction of uric acid in paediatric patients at risk for TLS. However, the safety and efficacy of rasburicase for the treatment or or prevention of TLS has not been prospectively evaluated. Children with newly diagnosed stage III-IV, bone marrow(+) and/or central nervous system(+) mature B-NHL received hydration and rasburicase prior to cytoreductive therapy. Rasburicase was safe and well-tolerated and there were no grade III-IV toxicities probably or directly related to rasburicase. Patients with an initial lactate dehydrogenase ≥2× upper limit of normal had a significantly elevated uric acid level (P = 0·005), increased incidence of TLS (P-0·005) and lower glomerular filtration rate (GFR; P < 0·001). Following rasburicase, there was only a 9% and 5% incidence of LTLS and CTLS, respectively. Furthermore, there was a significant improvement in estimated GFR from Day 0 to Day 7 following rasburicase (P = 0·0007) and only 1·3% of patients required new onset renal assisted support after rasburicase administration. A TLS strategy incorporating rasburicase prior to cytoreductive chemotherapy proved safe and effective in preventing new onset renal failure and was associated with a significant improvement in GFR.

Síndrome da lise tumoral: uma revisão para o clínico / Tumor lysis syndrome: a review for the clinician

JUSTIFICATIVA E OBJETIVOS: As possibilidades terapêuticas para o câncer cresceram muito nos últimos anos. A possibilidade de urgências relacionadas aos pacientes sobreviventes em tratamento do câncer vem crescendo muito. A síndrome da lise tumoral (SLT) é uma emergência oncológica metabólica que exige do médico emergencista uma abordagem específica e adequada. O objetivo deste estudo foi rever o assunto e trazer aspectos atuais de seu tratamento.CONTEÚDO: A SLT é uma emergência oncológica que nos últimos anos vem sendo associada com um número cada vez maior de tipos de câncer. Avaliar seus fatores de risco e promover adequada profilaxia pode diminuir sua incidência. As consequências da SLT são um conjunto de anormalidades metabólicas: hiperfosfatemia,hipocalcemia, hiperuricemia, hipercalemia, além de lesão renal aguda, insuficiência cardíaca, retenção volêmica e efeitos neuromusculares,neurológicos e gastrointestinais que devem ser prontamente diagnosticados e tratados pelo médico emergencista. CONCLUSÃO: A SLT é uma emergência que pode levar a morte ou prejudicar muito a possibilidade do paciente receber a terapia citotóxica. Dessa forma é fundamental o rápido alívio dos sintomas e a rápida correção das suas alterações metabólicas.

BACKGROUND AND OBJECTIVES: The therapeutic possibilities for cancer increased greatly in recent years. The possibility of emergencies related to patients surviving cancer treatment has been increasing. The tumor lysis syndrome (TLS) is a metabolic oncologic emergency that requires the emergency physician to have a specific and adequate approach. This study aimed at reviewing the theme and bringing current aspects for its treatment. CONTENTS: TLS is an oncologic emergency that in recent years has been associated with an increasing number of cancer types. Assessing its risk factors and promoting appropriate prophylaxis can decrease its incidence. The consequences of TLS are a set of metabolic abnormalities: hyperphosphatemia, hypocalcemia, hyperuricemia, hyperkalemia, and acute kidney injury, heart failure, volume retention, replacement, and neuromuscular, neurological and gastrointestinal effects that should be promptly diagnosed and treated by the emergency physician. CONCLUSION: Clinical TLS is an emergency that can lead to death or can severely impair the possibility of patients receiving an adequate cytotoxic therapy. Thus, rapid relief of symptoms and prompt correction of all metabolic alterations related to TLS are mandatory.

[Tumor lysis syndrome].

Recently, the ASCO guideline has added TLS. Prevention and recognition of the disease and state are important. Molecular targeting drugs, small molecule tyrosine kinase inhibitors and monoclonal antibodies induced rapid regression of the tumors and carry a risk of TLS. The recognition of the disease which may have a high risk of TLS and laboratory TLS is important.

Spontaneous tumor lysis syndrome in acute myeloid leukemia: two cases and a review of the literature.

Spontaneous tumor lysis syndrome (TLS) is a constellation of electrolyte abnormalities and acute renal failure, which occurs in the setting of rapid cell turnover prior to the administration of cytotoxic chemotherapy. While spontaneous TLS is well described in patients with Burkitt's lymphoma, it is thought to occur less commonly in other hematologic malignancies. We present two cases of spontaneous TLS in patients with newly diagnosed acute myeloid leukemia (AML) followed by a review of the literature in this field.

Tumor lysis syndrome: pathophysiology, definition, and alternative treatment approaches.

Tumor lysis syndrome (TLS), a life threatening metabolic syndrome seen in malignancies with high tumor burden, is reviewed in this article. The new Cairo and Bishop classification system is discussed as well as the clinical management of this syndrome. Special emphasis is placed on the use of a relatively new agent, rasburicase, as an alternative to allopurinol in the management of TLS-associated hyperuricemia.

Urgencias oncológicas / Oncology urgency

Las urgencias oncológicas son un capítulo importante dentro de la oncología pediátrica y de especial interés, tanto para los médicos generales como pediatras, ya que éstas son causa de morbimortalidad en pacientes con cáncer y pueden estar presentes desde el momento del diagnóstico. Aunque existe una gran variedad de ellas, en este capítulo sólo abordaremos las de mayor frecuencia como son la lisis tumoral, muchas veces presente al momento del diagnóstico y que puede conducir a una insuficiencia renal; la hiperleucocitosis, que es capaz de producir enfermedad por lisis tumoral o por un síndrome de hiperviscosidad, que se manifiesta por complicaciones pulmonares y neurológicas, siendo la más grave de ellas la hemorragia intracraneala; finalmente revisaremos la urgencia oncológica más frecuente que es la neutropenia febril que es secundaria a la toxicidad por quimioterapia y que puede causar la muerte en estos pacientes.