B-cell lymphoma presenting with renal failure associated to spontaneous tumor lysis syndrome and urinary tract obstruction.
The acute tumor lysis syndrome (ATLS) may be a dramatic complication of anticancer treatment. It occurs mostly in haematological malignancies and less commonly in solid tumors. Spontaneous tumor lysis syndrome (STLS) has been reported more frequently in Burkitt's lymphomas than in other haematological tumors, and exceptionally in solid tumors like small-cell lung carcinoma and germ-cell tumors. We report on the case of a patient with a diffuse large B-cell lymphoma (DLBCL) of the urinary tract involved by acute renal failure due to STLS and complicated by obstructive uropathy subsequent to neoplastic infiltration of the bladder. Hyperhydration, urine alkalinization, urate oxidase administration and continuous veno-venous haemodiafiltration (CVVHDF) permitted to control the initial renal failure and to administer chemotherapy. The patient then developed chemotherapy-induced tumor lysis syndrome (TLS) controlled by urate oxidase administration, hyperhydration and urine alkalinization. The treatment of TLS and the differences between ATLS and STLS are discussed.
Naeije
G
G
Department of Intensive Care and Thoracic Oncology, Centre des Tumeurs de l'Universite Libre de Bruxelles, Bruxelles, Belgium.
Meert
A P
AP
Deneft
F
F
Meuleman
N
N
Sculier
J P
JP