[Incidence and Risk Assessment of Tumor Lysis Syndrome in Patients with Advanced Germ Cell Cancer].
Tumor lysis syndrome (TLS) is a major oncological emergency. TLS is common in patients with hematological malignancies, but it can occur across a spectrum of cancer types. Germ cell tumors (GCT) have rapid cancer cell turnover and often present with bulky metastasis. The international TLS expert consensus panel has recommended guidelines for a medical decision tree to assign low, intermediate and high risk to patients with cancer at risk for TLS. GCT is classified as intermediate risk for TLS, and the patients who have other TLS risks factors are classified to be at high risk for TLS. In this study, we retrospectively analyzed 67 patients with metastatic GCT who were treated with induction chemotherapy at Tsukuba University Hospital between 2000 and 2013. Thirty-one, 15 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Twelve patients (18%) were classified to be at high risk for TLS, and two patients were treated with allopurinol or rasburicase as prophylaxes for TLS. They did not show progression to laboratory TLS (L-TLS). In the remaining 10 TLS high-risk patients, three (30%) patients developed L-TLS after chemotherapy and started receiving oral allopurinol. As a result, no patients developed clinical TLS (C-TLS). In this study, 30% of TLS-high risk patients developed L-TLS without prophylactic treatment. Therefore, it is important to conduct TLS-risk stratification and consider prophylaxis such as rasburicase for advanced GCT patients at induction chemotherapy.
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Masahiro
M
Kurobe
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Koji
K
Kawai
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Ken
K
Tanaka
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Daishi
D
Ichioka
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Takayuki
T
Yoshino
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Shuya
S
Kandori
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Takashi
T
Kawahara
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Natsui
N
Waku
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Ei-Ichirou
E
Takaoka
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Takahiro
T
Kojima
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Akira
A
Joraku
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Takahiro
T
Suetomi
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Jun
J
Miyazaki
The Department of Urology, the University of Tsukuba, Institute of Clinical Medicine.
Hiroyuki
H
Nishiyama
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D018239:Seminoma / Q000150:complications / Q000188:drug therapy; D013736:Testicular Neoplasms / Q000150:complications* / Q000188:drug therapy; D015275:Tumor Lysis Syndrome / Q000209:etiology* / Q000517:prevention & control; D014503:Urate Oxidase / Q000627:therapeutic use; D055815:Young Adult
C469709:rasburicase; D014503:Urate Oxidase