title: Acute tumor lysis syndrome during oral fludarabine treatment for chronic lymphocytic leukemia. Role of treatment with rasburicase.
abstract: BACKGROUND
  Oral fludarabine is the first oral formulation of a purine analogue available for clinical use which has produced encouraging results in patients with B-cell chronic lymphocytic leukemia (CLL). It has a similar tolerability profile to that of the intravenous formulation. Acute tumor lysis syndrome (TLS) induced by fludarabine appears to be a fairly unusual complication during the treatment of CLL.
  
  
  METHODS
  The present report describes the case of a 78-year-old man who developed acute renal failure associated with TLS following the first course of oral fludarabine. Laboratory investigations fulfilled the TLS typical criteria, including hyperkalemia, marked hyperuricemia, hyperphosphatemia, hypocalcemia, and acute renal failure. Despite the many documented side effects of oral fludarabine, there is only one similar case of oral fludarabine-induced TLS reported to date. Conventional therapy with short-term supportive hemodialysis and a short treatment of rasburicase for 2 days achieved a complete recovery of renal function and a decrease of the urate level to within the normal range.
  
  
  CONCLUSIONS
  Clinicians should be alert to this potentially life-threatening metabolic emergency among CLL patients treated with oral fludarabine.
authors.affiliation: Department of Hematology, Hospital General de Lanzarote, Arrecife de Lanzarote, Spain. jmcvillas@hotmail.com
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Calvo-Villas
authors.forename: Basilio Martín
authors.initials: BM
authors.lastname: Urcuyo
authors.forename: Adelaida Morales
authors.initials: AM
authors.lastname: Umpierrez
authors.forename: Francisco
authors.initials: F
authors.lastname: Sicilia
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000209:etiology* / Q000517:prevention & control*; D014503:Urate Oxidase / Q000008:administration & dosage*; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; C469709:rasburicase; D014503:Urate Oxidase; D014740:Vidarabine; C024352:fludarabine