BACKGROUND: Tumor lysis syndrome (TLS) is an oncologic emergency resulting from cancer chemotherapy; delays in its recognition could be life-threatening. Early recognition of associated risk factors and its management may help prevent its occurrence. OBJECTIVE: To identify the risk factors for TLS among cancer patients at the Philippine Children’s Medical Center. METHODS: This was a retrospective case-control study. Categorical variables were compared using chi-square test and continuous variables were compared using independent t-test. The association between TLS and patients’ characteristics was determined through logistic regression analysis. RESULTS: Medical records of 712 patients with cancer seen between 2016-2020 were reviewed. Children with (n=35) and without (n=137) TLS were selected as cases and controls and matched for age and cancer type. Factors associated with TLS are underweight patients with BMI < 18.5 (cOR 0.33, 95% CI 0.11-0.98); patients with both hepatomegaly and splenomegaly were four times more likely to develop TLS (cOR 3.946, 95% CI 1.2-12.94) while patients with lymphadenopathy were twice more likely to develop TLS (cOR 2.309, 95% CI 1.02-5.21). Patients with elevated WBC, low phosphorus and high uric acid at baseline have increased odds of developing TLS. CONCLUSIONS After group matching for age and cancer type, factors associated with increased odds of TLS among pediatric cancer patients in PCMC are hepatosplenomegaly, lymphadenopathy, elevated WBC, low potassium level, low phosphorus and high uric acid at baseline with higher fluid balance.
tumor lysis syndrome

Humans ; Tumor Lysis Syndrome/drug therapy* ; Leukemia, Myeloid, Acute/pathology* ; Bridged Bicyclo Compounds, Heterocyclic/therapeutic use* ; Sulfonamides/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols ; Antineoplastic Agents/therapeutic use*

Dramatic advances in the care of patients with cancer have led to significant improvement in outcomes and survival. However, renal manifestations of the underlying cancer as well as the effects of anti-neoplastic therapies leave patients with significant morbidity and chronic kidney disease risks. The most common renal manifestations associated with cancer include acute kidney injury (AKI) in the setting of multiple myeloma, tumor lysis syndrome, post-hematopoietic stem cell therapy, and AKI associated with chemotherapy. Knowledge of specific risk factors, modification of risk and careful attention to rapid AKI diagnosis are critical for improving outcomes.
Acute Kidney Injury ; Diagnosis ; Drug Therapy ; Humans ; Multiple Myeloma ; Renal Insufficiency, Chronic ; Risk Factors ; Stem Cells ; Tumor Lysis Syndrome

No abstract available.
Bone Marrow ; Diagnosis ; Korea ; Neoplasm Metastasis ; Small Cell Lung Carcinoma ; Tumor Lysis Syndrome

Introduction: Tumor lysis syndrome (TLS) is a therapy-related complication resulting from the rapid lysis of malignant cells post-treatment. The control of serum uric acid level plays a key role in its prevention, thus, allopurinol is used. Febuxostat is a novel xanthine oxidase inhibitor and there are currently no recommendations for using such in the prevention of TLS, hence, this study was conducted. This study aims to determine the efficacy of febuxostat in the prevention of TLS. Methods: Extensive search for randomized controlled trials (RCT) focusing on the use of febuxostat in the prevention of TLS was done. Each article was appraised independently by the researchers. The data were analysed using Rev Man 5.3. Results: Two trials were included in this review. The study results revealed that febuxostat, when compared to allopurinol, was able to decrease serum uric acid as hyperuricemia is the hallmark of TLS. This decrease in serum uric acid was consistent in both studies. Serum uric acid levels at the end of the treatment showed a standard mean difference of -1.09 (95% CI-1.29, -0.88, p for heterogeneity <0.01, p for effect <0.01, I2 = 97%). The trend of both studies favored the efficacy of febuxostat. The adverse effects documented during the study period in both trials were mostly noted from the chemotherapeutic agents and none from the use of febuxostat. Conclusion Febuxostat was shown to be more effective than allopurinol in the prevention of TLS.
Febuxostat ; Tumor Lysis Syndrome ; Meta-Analysis

BACKGROUND: Bendamustine is a chemotherapeutic agent that has shown broad activity in patients with lymphoid malignancies. It contains both alkylating and nucleoside analog moieties, and thus, is not commonly used for stem cell mobilization due to concerns that it may adversely affect stem cell collection. Here we describe the lymphoma subset of a prospective, non-randomized phase II study of bendamustine, etoposide, and dexamethasone (BED) as a mobilization agent for lymphoid malignancies. METHODS: This subset analysis includes diffuse large B-cell lymphoma (N=3), follicular lymphoma (N=1), primary mediastinal B-cell lymphoma (N=1), and NK/T-cell lymphoma (N=1). Patients received bendamustine (120 mg/m² IV d 1, 2), etoposide (200 mg/m² IV d 1–3), and dexamethasone (40 mg PO d 1–4) followed by filgrastim (10 mcg/kg/d sc. through collection). RESULTS: We successfully collected stem cells from all patients, with a median of 7.9×10⁶/kg of body weight (range, 4.4 to 17.3×10⁶/kg) over a median of 1.5 days (range, 1 to 3) of apheresis. All patients who received transplants were engrafted using kinetics that were comparable to those of other mobilization regimens. Three non-hematologic significant adverse events were observed in one patient, and included bacterial sepsis (grade 3), tumor lysis syndrome (grade 3), and disease progression (grade 5). CONCLUSION: For non-Hodgkin lymphoma, mobilization with bendamustine is safe and effective.
Autografts* ; Bendamustine Hydrochloride* ; Blood Component Removal ; Body Weight ; Dexamethasone* ; Disease Progression ; Etoposide* ; Filgrastim ; Hematopoietic Stem Cell Mobilization ; Hematopoietic Stem Cells* ; Humans ; Kinetics ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Follicular ; Lymphoma, Non-Hodgkin* ; Prospective Studies ; Sepsis ; Stem Cells ; Transplantation, Autologous* ; Tumor Lysis Syndrome

PURPOSE: The purposes of this study were to develop a problem based learning (PBL) module for cancer symptom management and oncology emergencies, and to evaluate the module after applying it for students in an advanced practice nurse program for oncology. METHODS: This study was a methodological research project. We invited a total of 13 graduates from an advanced practice nurse program to evaluate topics for the PBL module development. Five experts developed a PBL module for a selected topic. Eight students from an advanced practice nurse program participated in the PBL learning experience and evaluated their learning experiences. RESULTS: Tumor lysis syndrome, pain, disseminated intravascular coagulation and hypercalcemia were evaluated to be the most relevant and needed topics for the module. Oncology emergency PBL module-tumor lysis syndrome was developed through expert validation. Evaluation of PBL learning was 3.76 (out of 4 points) in a pilot test. CONCLUSION: The new PBL module provided a positive learning experience to students. The new PBL module can be used as the standardized clinical practice education in the oncology advanced practice nurse program and developing further PBL modules for different topics is recommended.
Advanced Practice Nursing ; Disseminated Intravascular Coagulation ; Education ; Emergencies ; Humans ; Hypercalcemia ; Learning ; Oncology Nursing ; Problem-Based Learning* ; Tumor Lysis Syndrome

Tumor lysis syndrome is a serious complication of malignancy, resulting from the massive and rapid release of cellular components into the blood. Generally, it occurs after initiation of chemotherapy. The onset of spontaneous tumor lysis syndrome (STLS) before anti-cancer treatment is rare and occurs mostly in Burkitt lymphoma and non-Hodgkin's lymphoma. There are only a few case reports in children. Here, we report a case of STLS secondary to T-cell acute lymphoblastic leukemia (ALL), which presented with urinary stone and subsequent acute kidney injury with severe hyperuricemia. Occult malignancy should be considered in case of unexplained acute kidney injury with extreme hyperuricemia.
Acute Kidney Injury* ; Burkitt Lymphoma ; Child ; Drug Therapy ; Humans ; Hyperuricemia* ; Lymphoma, Non-Hodgkin ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; T-Lymphocytes ; Tumor Lysis Syndrome* ; Urinary Calculi*

BACKGROUND: Hyperleukocytosis is a medical emergency that is characterized by increased blood viscosity and predisposition to various neurological, pulmonary, and gastrointestinal complications. In addition, patients are at risk of the tumor lysis syndrome because of the increased tumor burden. Therapeutic leukapheresis is an important treatment for these emergent states. In this study, we retrospectively analyzed therapeutic leukapheresis procedures that were performed in our institution during the last 10 yr. METHODS: We retrospectively analyzed therapeutic leukapheresis procedures conducted from July 2005 to March 2015 at a tertiary care hospital. We present our observations, especially the procedural characteristics and hematological parameters before and after the aforementioned procedures. RESULTS: Seventy-two patients underwent a total of 146 therapeutic leukapheresis procedures. The average presenting white blood cell (WBC) count was 268×10(3)/µL, and ranged from 54×10(3)/µL to 673×10(3)/µL. After an average of two sessions, a statistically significant drop in the WBC counts was observed. The average WBC removal rates during the initial and entire therapeutic leukapheresis procedures of each patient were 33% and 46%, respectively. The platelet count and hemoglobin concentration were significantly reduced. CONCLUSIONS: Therapeutic leukapheresis significantly reduces peripheral WBC counts and is a safe and effective procedure for the treatment of hyperleukocytosis.
Blood Viscosity ; Emergencies ; Humans ; Leukapheresis* ; Leukemia ; Leukocytes ; Platelet Count ; Retrospective Studies ; Tertiary Healthcare* ; Tumor Burden ; Tumor Lysis Syndrome

Burkitt Lymphoma ; complications ; Child ; Female ; Humans ; Posterior Leukoencephalopathy Syndrome ; etiology ; Tumor Lysis Syndrome ; complications