Asystole during combination chemotherapy for non-Hodgkin's lymphoma: the acute tumor lysis syndrome.
The acute tumor lysis syndrome is a rare condition that has most frequently been documented in patients with rapidly dividing myeloproliferative and lymphoproliferative malignancies. It is characterized by the development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, acute renal failure and metabolic acidosis, as a result of massive tumor cell destruction, usually secondary to effective cytotoxic treatment. We want to present the case history of a 62-year-old woman who died from cardiorespiratory arrest during combination chemotherapy for non-Hodgkin's lymphoma due to acute tumor lysis syndrome. Despite general preventive measures, severe electrolyte abnormalities developed within 18 h of the start of chemotherapy. The general guidelines for the management of this potentially fatal oncologic emergency are discussed, with special emphasis on the pathogenetic mechanisms and risk factors in our patient.
Van Der Klooster
J M
JM
Departments of Internal Medicine and Intensive Care Medicine, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands.
Van Der Wiel
H E
HE
Van Saase
J L
JL
Grootendorst
A F
AF
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects; D015275:Tumor Lysis Syndrome / Q000209:etiology* / Q000628:therapy; D014750:Vincristine / Q000009:adverse effects
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone