Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase

<h3>Rationale</h3><p dir="ltr">Tumor lysis syndrome (TLS) is an oncological emergency that occurs due to diffuse tumor cell destruction with the massive release of intracellular electrolytes. Spontaneous tumor lysis syndrome (STLS) is the development of TLS before the com...

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Main Author: Abdulrahman F. Al-Mashdali (17148316) (author)
Other Authors: Mohamed A. Yassin (8361183) (author)
Published: 2022
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author Abdulrahman F. Al-Mashdali (17148316)
author2 Mohamed A. Yassin (8361183)
author2_role author
author_facet Abdulrahman F. Al-Mashdali (17148316)
Mohamed A. Yassin (8361183)
author_role author
dc.creator.none.fl_str_mv Abdulrahman F. Al-Mashdali (17148316)
Mohamed A. Yassin (8361183)
dc.date.none.fl_str_mv 2022-07-01T00:00:00Z
dc.identifier.none.fl_str_mv 10.1097/md9.0000000000000244
dc.relation.none.fl_str_mv https://figshare.com/articles/journal_contribution/Spontaneous_tumor_lysis_syndrome_in_a_patient_with_accelerated_phase_chronic_myeloid_leukemia_treated_successfully_with_rasburicase/29069552
dc.rights.none.fl_str_mv CC BY 4.0
info:eu-repo/semantics/openAccess
dc.subject.none.fl_str_mv Biomedical and clinical sciences
Cardiovascular medicine and haematology
Clinical sciences
Oncology and carcinogenesis
acute kidney injury
autoimmune hemolytic anemia
case report
chronic myeloid leukemia
rasburicase
tumor lysis syndrome
dc.title.none.fl_str_mv Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
dc.type.none.fl_str_mv Text
Journal contribution
info:eu-repo/semantics/publishedVersion
text
contribution to journal
description <h3>Rationale</h3><p dir="ltr">Tumor lysis syndrome (TLS) is an oncological emergency that occurs due to diffuse tumor cell destruction with the massive release of intracellular electrolytes. Spontaneous tumor lysis syndrome (STLS) is the development of TLS before the commencement of chemotherapy. To the best of our knowledge, there are no reported cases of STLS in the chronic or accelerated phase of chronic myeloid leukemia (CML).</p><h3>Patient concerns</h3><p dir="ltr">A 37-year-old woman of Arabic descent with a history of CML presented with a 3-day history of nausea and abdominal pain. She had not started any new treatment for CML within the last 3 months of presentation.</p><h3>Diagnosis</h3><p dir="ltr">The patient was diagnosed with hyperuricemia, hyperphosphatemia, hypocalcemia, and acute kidney injury. A peripheral blood smear confirmed the accelerated CML phase. Our patient met the criteria for clinical TLS, specifically, STLS. She was also diagnosed with autoimmune hemolytic anemia.</p><h3>Interventions</h3><p dir="ltr">The patient was started on intravenous normal saline (200 mL/h) and rasburicase (6 mg/d). In addition, hydroxyurea was used as a cytoreductive agent.</p><h3>Outcomes</h3><p dir="ltr">The creatinine level returned to normal within 48 hours of rasburicase initiation.</p><h3>Lessons</h3><p dir="ltr">Any patient with hematological malignancy should be monitored for TLS even before the initiation of chemotherapy. The exact mechanism of spontaneous TLS remains unknown, and further studies are needed to explain the pathophysiology of this condition. Rapid initiation of rasburicase, in addition to vigorous hydration, is effective in the treatment of acute kidney injury associated with TLS.</p><h2>Other Information</h2><p dir="ltr">Published in: Medicine: Case Reports and Study Protocols<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1097/md9.0000000000000244" target="_blank">https://dx.doi.org/10.1097/md9.0000000000000244</a></p>
eu_rights_str_mv openAccess
id Manara2_e04fd647bd85b7abc58b56af7f3fd235
identifier_str_mv 10.1097/md9.0000000000000244
network_acronym_str Manara2
network_name_str Manara2
oai_identifier_str oai:figshare.com:article/29069552
publishDate 2022
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spelling Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicaseAbdulrahman F. Al-Mashdali (17148316)Mohamed A. Yassin (8361183)Biomedical and clinical sciencesCardiovascular medicine and haematologyClinical sciencesOncology and carcinogenesisacute kidney injuryautoimmune hemolytic anemiacase reportchronic myeloid leukemiarasburicasetumor lysis syndrome<h3>Rationale</h3><p dir="ltr">Tumor lysis syndrome (TLS) is an oncological emergency that occurs due to diffuse tumor cell destruction with the massive release of intracellular electrolytes. Spontaneous tumor lysis syndrome (STLS) is the development of TLS before the commencement of chemotherapy. To the best of our knowledge, there are no reported cases of STLS in the chronic or accelerated phase of chronic myeloid leukemia (CML).</p><h3>Patient concerns</h3><p dir="ltr">A 37-year-old woman of Arabic descent with a history of CML presented with a 3-day history of nausea and abdominal pain. She had not started any new treatment for CML within the last 3 months of presentation.</p><h3>Diagnosis</h3><p dir="ltr">The patient was diagnosed with hyperuricemia, hyperphosphatemia, hypocalcemia, and acute kidney injury. A peripheral blood smear confirmed the accelerated CML phase. Our patient met the criteria for clinical TLS, specifically, STLS. She was also diagnosed with autoimmune hemolytic anemia.</p><h3>Interventions</h3><p dir="ltr">The patient was started on intravenous normal saline (200 mL/h) and rasburicase (6 mg/d). In addition, hydroxyurea was used as a cytoreductive agent.</p><h3>Outcomes</h3><p dir="ltr">The creatinine level returned to normal within 48 hours of rasburicase initiation.</p><h3>Lessons</h3><p dir="ltr">Any patient with hematological malignancy should be monitored for TLS even before the initiation of chemotherapy. The exact mechanism of spontaneous TLS remains unknown, and further studies are needed to explain the pathophysiology of this condition. Rapid initiation of rasburicase, in addition to vigorous hydration, is effective in the treatment of acute kidney injury associated with TLS.</p><h2>Other Information</h2><p dir="ltr">Published in: Medicine: Case Reports and Study Protocols<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1097/md9.0000000000000244" target="_blank">https://dx.doi.org/10.1097/md9.0000000000000244</a></p>2022-07-01T00:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1097/md9.0000000000000244https://figshare.com/articles/journal_contribution/Spontaneous_tumor_lysis_syndrome_in_a_patient_with_accelerated_phase_chronic_myeloid_leukemia_treated_successfully_with_rasburicase/29069552CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/290695522022-07-01T00:00:00Z
spellingShingle Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
Abdulrahman F. Al-Mashdali (17148316)
Biomedical and clinical sciences
Cardiovascular medicine and haematology
Clinical sciences
Oncology and carcinogenesis
acute kidney injury
autoimmune hemolytic anemia
case report
chronic myeloid leukemia
rasburicase
tumor lysis syndrome
status_str publishedVersion
title Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
title_full Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
title_fullStr Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
title_full_unstemmed Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
title_short Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
title_sort Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
topic Biomedical and clinical sciences
Cardiovascular medicine and haematology
Clinical sciences
Oncology and carcinogenesis
acute kidney injury
autoimmune hemolytic anemia
case report
chronic myeloid leukemia
rasburicase
tumor lysis syndrome