Acute tumor lysis syndrome in patients with high-grade non-Hodgkin's lymphoma.
OBJECTIVE
To identify patients with lymphoma at risk for tumor lysis after chemotherapy.


METHODS
The case records of 102 patients receiving combination chemotherapy for non-Hodgkin's lymphoma (intermediate to high-grade histology) were reviewed. Patients were considered to have "laboratory tumor lysis" if two of the following metabolic changes occurred within 4 days of treatment: a 25% increase in the serum phosphate, potassium, uric acid, or urea nitrogen concentrations, or a 25% decline in the serum calcium concentration. "Clinical tumor lysis" was defined as laboratory tumor lysis plus one of the following: a serum potassium level greater than 6 mmol/L, a creatinine level greater than 221 mumol/L, or a calcium level less than 1.5 mmol/L, the development of a life-threatening arrhythmia, or sudden death.


RESULTS
Laboratory tumor lysis occurred in 42% of patients and clinical tumor lysis in 6%. There was no statistical difference in the frequency of either tumor lysis syndrome among lymphoma subgroups. Clinical tumor lysis occurred more frequently in patients with pretreatment renal insufficiency (serum creatinine level greater than 132 mumol/L) than in patients with normal renal function (36% versus 2%; p = 0.01). The development of azotemia correlated with high pretreatment serum lactate dehydrogenase concentrations (p < 0.01; r2 = 0.11).


CONCLUSIONS
Clinically significant tumor lysis is a rare occurrence in patients with lymphoma when they are receiving allopurinol. However, tumor lysis can occur in patients with all types of moderate to high-grade non-Hodgkin's lymphoma. Patients with a high serum lactate dehydrogenase level or renal insufficiency are at increased risk for metabolic complications after chemotherapy and should be closely monitored.
Hande
K R
KR
Department of Medicine, Vanderbilt University, Nashville, Tennessee.
Garrow
G C
GC
D000208:Acute Disease; D000493:Allopurinol / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001806:Blood Urea Nitrogen; D002051:Burkitt Lymphoma / Q000097:blood / Q000188:drug therapy; D003404:Creatinine / Q000097:blood; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology; D006996:Hypocalcemia / Q000209:etiology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood / Q000188:drug therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000188:drug therapy*; D016399:Lymphoma, T-Cell / Q000097:blood / Q000188:drug therapy; D010710:Phosphates / Q000097:blood; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000209:etiology*; D014527:Uric Acid / Q000097:blood
D010710:Phosphates; D014527:Uric Acid; D000493:Allopurinol; D003404:Creatinine; D007770:L-Lactate Dehydrogenase