[Bortezomib-induced tumor lysis syndrome with a remarkable elevation of LDH in a case of relapsed and therapy-resistant multiple myeloma].
A 60-year-old female patient with a therapy-resistant Bence-Jones (BJ) lambda-type multiple myeloma was treated with bortezomib. She had been treated with tandem autologous stem cell transplantations and achieved complete remission before her disease relapsed. Sixteen hours after the first administration of bortezomib, an episode of fever, slight consciousness disturbance and vomiting occurred, which was accompanied by a remarkable elevation of LDH (3608 IU/l). Serum levels of creatinine, uric acid, and AST were also transiently elevated. Serum interleukin-6 level was also increased after the administration of bortezomib. The symptoms disappeared rapidly within 48 hours. Bortezomib at a 25%-reduced dose was administered again along with dexamethasone 26 days later, which caused a moderate increase in LDH levels, but no other symptoms. Further treatment caused no increase in LDH. The treatment was very effective and eradicated both urinary BJ protein and bone marrow myeloma cells after 8 sessions of bortezomib administration. These findings suggest that a bortezomib-induced rapid reduction in tumor burden led to tumor lysis syndrome, for which caution is needed when treating myeloma patients with this very effective agent.
Arai
Ayako
A
Department of Hematology, Tokyo Medical and Dental University.
Oshikawa
Gaku
G
Kurosu
Tetsuya
T
Miki
Tohru
T
Tohda
Shuji
S
Koyama
Takatoshi
T
Murakami
Naomi
N
Miura
Osamu
O
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001536:Bence Jones Protein / Q000652:urine; D015415:Biomarkers / Q000652:urine; D001897:Boronic Acids / Q000008:administration & dosage* / Q000009:adverse effects*; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000628:therapy*; D011719:Pyrazines / Q000008:administration & dosage* / Q000009:adverse effects*; D012008:Recurrence; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000209:etiology*
D000970:Antineoplastic Agents; D015415:Biomarkers; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D003907:Dexamethasone; D001536:Bence Jones Protein; D007770:L-Lactate Dehydrogenase