急性淋巴细胞白血病并发肿瘤溶解综合征7例

目的：探讨急性淋巴细胞白血病（ＡＬＬ）患者化疗后发生肿瘤溶解综合征（ＴＬＳ）的临床特征。方法：对７例化疗发生ＴＬＳ的ＡＬＬ患者进行各项生化指标的分析。结果：ＴＬＳ患者表现为高尿酸血病、高血钾、高血磷、低血钙，并有不同程度的肾功能损伤，其中１例发生了急性肾功能不全。用别嘌呤醇及静脉碱化利尿后，６例短期内血生化指标恢复正常。１例死于心衰。结论：早期诊断并及时给予别嘌呤醇及静脉碱化利尿是治疗ＴＬＳ的关键。     

VAD方案治疗ALL伴发高白细胞综合征(病例报道并文献复习)

目的 :报道 1例初诊急性淋巴细胞性白血病 (AL L)患者合并弥漫性血管内凝血(DIC)及高白细胞综合征 ,经 VAD方案化疗并及时纠正 DIC治疗后完全缓解 (CR) ,并进行文献复习。方法 :1例初诊 AL L 患者 ,4 1岁男性 ,诊断时伴有高白细胞综合征多脏器浸润 (WBC392× 1 0 9/ L)DIC、低氧血症、大量腹水及心肌酶、尿酸明显升高 ,骨髓穿刺 :增生极度活跃 ,原 +幼淋 89.5 % ,提示AL L。入院后立即予 VAD方案化疗 ,同时水化、碱化尿液、利尿 ,小剂量肝素持续静点及间断输注纤维蛋白原纠正 DIC。结果 :患者临床症状明显好转 ,血象、凝血功能、D-二聚体、肝、肾功能、血气、心肌酶等亦逐渐恢复正常 ,复查骨髓示 :原 +幼淋占 1 % ,AL L- CR。结论 :VAD方案中大剂量激素可达到快速减低肿瘤负荷的目的 ,且激素不引起大量肿瘤细胞崩解 ,较少发生溶瘤综合征。对高白细胞性AL L 有较好的治疗效果     

小细胞肺癌化疗后出现急性肿瘤溶解综合征一例报告

急性肿瘤溶解综合征 (acutetumorlysissyndrome ,ATLS)是对化疗药物敏感或肿瘤负荷重的肿瘤细胞经有效治疗后 ,大量肿瘤细胞溶解坏死破坏 ,快速释放其内容物而导致的一组代谢异常和电解质紊乱的症候群。它具有以下几项或全部特征 :高尿酸血症、高钾血症、高磷血症、低钙血症、代谢性酸中毒和肾功能不全。ATLS并不常发生 ,一旦发生 ,往往致命。ATLS较常见于恶性淋巴瘤或白血病患者 ,实体肿瘤患者中较少见。我们发现 1例小细胞肺癌患者化疗后出现ATLS ,经过积极的补液、碱化尿液和口服别嘌呤醇 ,纠正电解质紊乱及酸碱平衡失调 ,患者逐…     

化疗药物体外诱导白血病细胞凋亡与临床疗效的关系

目的 :探索急性淋巴细胞白血病 (AL L)患者体外化疗药物诱导白血病细胞凋亡在化疗疗效预测中的价值。方法 :应用 Td T介导的脱氧核苷酸切口和末端标记法 (Tunel)、单克隆抗体免疫组化检测等方法研究 2 8例初治 AL L 患者体外化疗药物诱导白血病细胞凋亡、bcl- 2表达与临床化疗疗效的关系。结果 :2 8例 AL L 患者中 ,2 0例获完全缓解 (CR)者 ,bcl- 2表达显著低于 8例未缓解(NR)者 (P<0 .0 5 ) ;CR患者长春新碱 (VCR)、柔红霉素 (DNR)和地塞米松 (DXM)体外诱导白血病细胞凋亡率均高于 NR患者 ,差异有显著性 (P均 <0 .0 5 ) ;体外 VCR、DNR和 DXM3种药诱导白血病细胞的总凋亡率 ,可以作为临床预测 AL L 患者 VDCP方案疗效的定量指标。结论 :体外化疗药物能否有效地诱导白血病细胞凋亡是判断 AL L 患者化疗敏感性的重要指标     

急性白血病患者化疗后肠道感染临床分析

目的 分析急性白血病(AL)患者化疗后发生肠道感染的临床特征.方法 回顾性分析2014年1月至2016年4月收治的103例化疗后发生肠道感染AL患者的临床资料,分类变量组间比较采用χ2检验.结果 103例患者共进行364个周期化疗,其中59个化疗周期中发生66例次(18.13%)肠道感染,包括7例次在同一个疗程出现2次肠道感染.未完全缓解(CR)组肠道感染发生率27.48%(36/131),CR组9.87%(23/233),两组差异有统计学意义(P<0.01).多个化疗周期中重复肠道感染发生率达46.67%.同一化疗周期,对于在化疗期间出现肠道感染的患者,化疗后再次肠道感染发生率为化疗期间未发生肠道感染者的3.7倍.初次诱导化疗的急性淋巴细胞白血病患者肠道感染发生率比急性髓系白血病高(P=0.019).中性粒细胞缺乏合并肠道感染发生率为9.89%(36/364),中性粒细胞计数>0.5×109/L时肠道感染发生率为8.24%(30/364),两组差异无统计学意义(P>0.05).AL化疗后肠道感染患者部分发生急腹症,死亡率高.结论 AL患者在化疗期间及骨髓抑制期均会出现肠道感染,必须引起重视,减少血流感染及危险因素,及时干预.     

小细胞肺癌化疗后出现急性肿瘤溶解综合征一例报告

急性肿瘤溶解综合征(acute tumor lysis syndrome，ATLS)是对化疗药物敏感或肿瘤负荷重的肿瘤细胞经有效治疗后，大量肿瘤细胞溶解坏死破坏，快速释放其内容物而导致的一组代谢异常和电解质紊乱的症候群。它具有以下几项或全部特征：高尿酸血症、高钾血症、高磷血症、低钙血症、代谢性酸中毒和肾功能不全。ATLS并不常发生，一旦发生，往往致命。ATLS较常见于恶性淋巴瘤或白血病患者，实体肿瘤患者中较少见。我们发现1例小细胞肺癌患者化疗后出现ATLS，经过积极的补液、碱化尿液和口服别嘌呤醇，纠正电解质紊乱及酸碱平衡失调，患者逐渐恢复正常。     

急性淋巴细胞性白血病可用bcr/abl基因做微小残留病的标志

目的 :检测急性淋巴细胞白血病 (AL L)完全缓解后微小残留病 (MRD) ,探讨其临床意义。方法 :应用反转录 -巢式聚合酶链反应 (nest- PCR)检测 AL L 完全缓解后 bcr/abl m RNA。结果 :2 3例 AL L 患者中阳性 5例 ,5例阳性者 2月～ 13月内复发 ;而 MRD阴性的 18例中 2例于缓解后 2月、4月复发 ,余 16例无复发。结论 :AL L治疗完全缓解 (CR)后仍存在 MRD者有较高的复发危险 ,应进行巩固治疗和定期监测 ;MRD阴性可以做为临床疗效观察的客观指标。该方法检测 MRD敏感度高 ,适用于临床。     

分次小剂量顺铂联合化疗对胃癌患者肾功能的影响

背景与目的:大剂量顺铂化疗对肾功能的损害已有共识,但小剂量的顺铂化疗对肾功能的影响还有待进一步考证,本研究旨在观察分次小剂量顺铂为主的联合化疗方案对胃癌患者肾功能的影响.方法:31例胃癌患者均采用分次小剂量顺铂(20 mg/m2,第1～3天)联合氟尿嘧啶、表阿霉素静脉化疗,于化疗前至化疗第14天,隔日查尿N-乙酰-β-D-葡萄糖苷酶(N-acetyl-β-D-glucosaminidase,NAG)、γ-谷氨酰转酞酶(gamma-glutamyltransferase,γ-GT)及尿常规,化疗第7天及第14天查血肌酐及血尿素氮.结果:31例患者中有13例在化疗前各项检查指标均正常,而化疗后各项指标正常者仅1例.18例化疗前有1项或多项指标异常,多为尿NAG、γ-GT增高,两者在化疗第4天明显增高,2周左右仍未降至正常水平;而血肌酐及尿素氮无明显变化.结论:分次小剂量顺铂联合化疗对患者肾功能仍有一定影响,且持续时间较长.     

乳腺癌化疗所致脂肪肝的临床分析

目的:探讨乳腺癌患者化疗后脂肪肝的发生和预后。方法:分析288例乳腺癌患者化疗前后患者肝脏超声表现及实验室血生化指标(AST、ALT及TG、CHOL、LDL-C)的变化。入选条件:本组病例分别具有化疗前和化疗后完整的肝脏超声资料和实验室肝功能及血脂生化指标,化疗前肝脏超声表现和(或)实验室指标异常者除外。结果:化疗后288例乳腺癌患者中84例经超声诊断为脂肪肝,发病率为29.2%,288例乳腺癌患者实验室肝功能及血脂指标(AST、ALT及TG、CHOl、LDL-C)均有不同程度升高,化疗前后实验室结果差异显著(P<0.05)。结论:乳腺癌患者化疗后可以导致肝脏的脂肪变,部分发展为脂肪肝。     

急性白血病患者血浆H2S水平测定临床意义分析

目的:探讨急性白血病(AL)患者血浆内源性H2S水平变化及意义.方法:初治AL住院患者62例,健康体检者20例.应用敏感硫电极法测定其血浆中的H2S浓度水平,比较AL患者急性发病期、临床缓解期与健康对照组之间和不同分型之间的差异.结果:AL患者血浆中的H2S浓度水平急性发病期组[(29.00±8.36) μmol/L]较临床缓解期组[(44.53±5.98) μmol/L]和健康对照组[(47.66±6.13) μmol/L]明显降低,差异有统计学意义,P=0.000;临床缓解期组血浆中的H2S浓度水平比较健康对照组,差异无统计学意义,P=0.058,但H2S浓度明显低于健康对照组;急性淋巴细胞白血病患者的H2S含量为(28.98±8.77) μmol/L,急性髓系白血病为(28.16土6.04)μmol/L,差异无统计学意义,P=0.88.结论:气体信号分子H2S生成下降可能在AL的发病过程中发挥重要作用.     

Tumour lysis syndrome in children: experience of last decade

The strategy against tumour lysis syndrome (TLS) had been hyperhydration, urine alkalinization, and allopurinol. Recently, rasburicase was added to the armament against this life-threatening condition. In Korea, rasburicase is used as a rescue therapy for cases with allopurinol-resistant hyperuricemia, because of the restriction by the National Health Insurance. We reviewed our experiences to re-assess the risk factors of TLS and the efficacy of rasburicase. Medical records were retrospectively reviewed for 396 children who were diagnosed as positive with acute leukemia and non-Hodgkin lymphoma between the years 2000 and 2009. The risk factors for TLS were analyzed statistically, and those before and after the availability of rasburicase were compared. Sixty eight patients (17.2%) had TLS. Multivariate analysis showed that pre-chemotherapy hypophosphatemia was a risk factor for TLS, in addition to the known risk factors of hyperuricemia and high lactate dehydrogenase concentration. The availability of rasburicase as a rescue therapy did not negate the importance of uric acid as a risk factor of TLS. Rasburicase as a second line treatment for intractable hyperuricemia was not effective in reducing the incidence of TLS. Pre-chemotherapy hypophosphatemia was a significant independent risk factor for TLS.     

Acute tumor lysis syndrome in solid tumors—a case report and review of the literature

PURPOSE: Tumor lysis syndrome (TLS) is a potential complication in cancer therapy. It may occur in highly sensitive tumors, especially in childhood cancers and acute leukemias, whereas it is rare in the treatment of adult solid tumors. TLS is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia following massive lysis of malignant cells. Complications include acute renal failure and metabolic acidosis. We report the first case of TLS during chemotherapy in a patient with metastatic medulloblastoma, together with a review of the literature regarding the occurrence of TLS in patients with solid tumors. METHODS: Data regarding clinical and biochemical parameters were extracted from the actual patients' files. Reports of TLS in the English language literature up to 2002 were identified by searching Medline. RESULTS: A 23-year old male with metastatic medulloblastoma received chemotherapy with cisplatin and etoposide due to massive extracerebral manifestations including metastases to the liver, mediastinal lymph nodes and bone marrow metastases. The patient developed classical signs of TLS on the second day of chemotherapy, including acute renal failure. A 17-fold increase in plasma LDH up to 87608 U/l was observed together with a 4-fold increase in plasma creatinine. The patient was treated with aggressive hydration, allopurinol and repeated hemodialysis. During the following days the patient improved and the biochemical markers all returned to normal. REVIEW. Reviewing the literature, a total of 45 patients with solid tumors who developed TLS have been reported. Most of the patients presented with metastatic, therapy-sensitive disease. Although preventable in practically 100% of patients, TLS is a potentially fatal complication, and in this material the mortality rate was one in three. Risk factors included increased LDH, hyperuricemia and pretreatment azotemia. CONCLUSIONS: TLS is only rarely associated with treatment of solid tumors. Precautions should be taken to avoid this potentially fatal complication in (chemo)therapy of solid tumors, especially in therapy-sensitive tumors presenting with bulky, metastatic disease and preexisting risk factors, including azotemia, elevated LDH and hyperuricemia. Prophylactic treatment to avoid TLS includes allopurinol, hydration prior to treatment and alkalization of the urine. Urate oxidase (rasburicase) is now beginning to replace allopurinol as a more effective way of reducing hyperuricemia and thereby the risk of TLS.     

Management of tumor lysis syndrome in adults

Spontaneous or treatment-induced tumor lysis syndrome (TLS) can cause significant morbidity and potential mortality. Vigorous hydration, alkalinization and inhibition of uric acid synthesis with allopurinol are the most frequently used methods for treatment and prevention of TLS. However, this approach fails to prevent renal insufficiency in up to 25% of high-risk patients. With the increased intensity and efficacy of cancer therapies, novel approaches for the management of TLS are needed. Unlike allopurinol, urate oxidase promptly reduces the existing uric acid pool, prevents accumulation of xanthine and hypoxanthine and does not require alkalinization, facilitating phosphorus excretion. A recombinant form of urate oxidase, rasburicase, is now registered for the treatment and prevention of TLS. This review provides an overview of rasburicase development and discusses the impact of rasburicase in the prevention and management of TLS.     

Management of tumor lysis syndrome in adults

Spontaneous or treatment-induced tumor lysis syndrome (TLS) can cause significant morbidity and potential mortality. Vigorous hydration, alkalinization and inhibition of uric acid synthesis with allopurinol are the most frequently used methods for treatment and prevention of TLS. However, this approach fails to prevent renal insufficiency in up to 25% of high-risk patients. With the increased intensity and efficacy of cancer therapies, novel approaches for the management of TLS are needed. Unlike allopurinol, urate oxidase promptly reduces the existing uric acid pool, prevents accumulation of xanthine and hypoxanthine and does not require alkalinization, facilitating phosphorus excretion. A recombinant form of urate oxidase, rasburicase, is now registered for the treatment and prevention of TLS. This review provides an overview of rasburicase development and discusses the impact of rasburicase in the prevention and management of TLS.     

Allopurinol: intravenous use for prevention and treatment of hyperuricemia.

PURPOSE: To tabulate data obtained over a 21-year period to determine the efficacy and safety of an intravenous (IV) allopurinol preparation. PATIENTS AND METHODS: IV allopurinol was provided on a compassionate plea basis to patients of any age in whom xanthine oxidase inhibitor therapy was indicated as an adjunct to chemotherapy and for whom oral intake was restricted. Three hundred twenty-seven investigators at multiple hospitals in the United States treated 1,172 patients with IV allopurinol. The vast majority of these patients had a malignancy and were in danger of developing tumor lysis syndrome (TLS) and subsequent acute uric acid nephropathy (AUAN) and were unable to take oral allopurinol. Data referable to the time period of IV allopurinol administration were collected, collated, and analyzed retrospectively. There was no randomization. RESULTS: In patients initiating treatment for an elevated serum uric acid (SUA), the SUA normalized or improved in 87% of adult patients and normalized or improved in 95% of pediatric patients. IV allopurinol, administered prophylactically to patients at high risk of developing hyperuricemia and TLS, prevented an increase in SUA levels in 93% of adults and 92% of children. Toxicities caused by IV allopurinol were minimal and consisted of 10 instances of mild to moderate skin or allergic reactions. CONCLUSION: IV allopurinol is as efficacious and safe as oral allopurinol and will be of significant benefit to patients at risk of TLS and AUAN and unable to take oral medication.     

Recombinant urate oxidase for prevention of hyperuricemia and tumor lysis syndrome in lymphoid malignancies

Hyperuricemia is a common manifestation of lymphoid malignancies at diagnosis or after the start of chemotherapy. When accompanied by other metabolic abnormalities and/or organ failure, hyperuricemia may be a manifestation of tumor lysis syndrome (TLS). Patients at particularly high risk of such complications include those with acute lymphoblastic leukemia and advanced stage non-Hodgkin's lymphoma. Conventional measures to prevent hyperuricemia and TLS are comprised of hydration, alkalinization of body fluids, and administration of allopurinol. Although these measures are usually effective in preventing or managing hyperuricemia, approximately 20% of patients at high risk of TLS require dialysis, and many cannot receive chemotherapy as planned. Rasburicase, a recombinant form of the enzyme urate oxidase, has recently become available and may further reduce the morbidity of hyperuricemia and TLS. In this review, we provide an overview of hyperuricemia and TLS and discuss the impact of rasburicase in the overall management of these complications.     

Acute tumor lysis syndrome in a hemodialysis patient with diffuse large B cell lymphoma

Acute tumor lysis syndrome (TLS) is a life-threatening complication of cancer therapy requiring prompt recognition and aggressive management. It occurs particularly in patients with lymphoproliferative disease during potent myelosuppressive therapy. To our knowledge, acute TLS in end-stage renal disease (ESRD) patients with malignancy is extremely rare and has never been reported in English literature. We report the first case of acute TLS in an ESRD woman with diffuse large B cell lymphoma after chemotherapy. Aggressive treatments with daily hemodialysis and allopurinol rather than hydration benefit the patient. There is neither optimal therapy in treating ESRD patients with TLS nor adequate guidelines for how to adjust the chemotherapy drug in hemodialysis patients. This case provides our experience to clinician how to treat acute TLS in ESRD patients.     

Rasburicase: potential role in managing tumor lysis in patients with hematological malignancies

Acute tumor lysis syndrome with hyperuricemia and renal failure usually occurs during the initial period of chemotherapy in patients with aggressive hematological malignancies. Standard therapy for hyperuricemia includes hydration, urine alkalinization and pharmacoreduction of uric acid with allopurinol. In the USA, rasburicase has recently been approved by the US Food and Drug Administration for the reduction of uric acid. Rasburicase is a recombinant urate oxidase enzyme that converts uric acid to allantoin, which has increased urine solubility. It is administered intravenously once-daily and leads to rapid, dramatic declines in serum uric acid values. The toxicity profile is excellent, with rare incidence of bronchospasm and allergies and a known contraindication for patients with glucose-6-phosphate dehydrogenase deficiency. A Phase III trial in high-risk pediatric patients conclusively demonstrated that rasburicase is more effective than allopurinol in controlling uric acid. Ongoing evidence is accumulating suggesting that the drug is also safe and effective in adults with hematological malignancies.     

The effect of initial management of hyperleukocytosis on early complications and outcome of children with acute lymphoblastic leukemia

Data were collected from 124 patients with newly diagnosed acute lymphoblastic leukemia (ALL) and WBC greater than 200,000/microL seen at institutions affiliated with the Children's Cancer Study Group (CCSG) from April 1981 to May 1983. The presenting characteristics, initial management, early complications, and outcome were reviewed. All the children received vigorous intravenous (IV) hydration, alkalinization of the urine, and allopurinol. Thirty-two patients were started on full therapy with no additional measure. One or more special measures believed to reduce the complications of leukostasis and blast cell lysis were administered to 92 patients as follows: small initial doses of prednisone, 63; emergency cranial irradiation, 26; exchange transfusion, 21; and leukopheresis, 19. The incidence of CNS hemorrhage was only 3% (4/124). Seven patients expired during induction and four failed to achieve a remission by day 28. Nineteen patients (15%) had documented bacterial or fungal sepsis. Mild to moderate electrolyte abnormalities occurred in 29 patients: three patients required renal dialysis. Pretreatment with small doses of prednisone did not decrease the incidence of electrolyte abnormalities in those patients when compared with patients who received full chemotherapy. The event-free survival (EFS) for the 106 patients treated on one of the three intensive pilot studies is 55% at 36 months. On multivariate analysis the two significant adverse prognostic factors were massive splenomegaly (P = .02) and WBC count greater than 600,000/microL (P = .05). In conclusion, in patients with hyperleukocytosis the complications of blast cell lysis and leukostasis were manageable with acceptable morbidity and minimal mortality in a group of patients treated with vigorous hydration, allopurinol, and alkalinization of the urine before beginning chemotherapy. Selected patients with severe hyperuricemia and renal dysfunction may benefit from leukopheresis. No beneficial role was demonstrated for the use of small initial doses of prednisone or emergency cranial irradiation.     

Rasburicase: potential role in managing tumor lysis in patients with hematological malignancies

Acute tumor lysis syndrome with hyperuricemia and renal failure usually occurs during the initial period of chemotherapy in patients with aggressive hematological malignancies. Standard therapy for hyperuricemia includes hydration, urine alkalinization and pharmacoreduction of uric acid with allopurinol. In the USA, rasburicase has recently been approved by the US Food and Drug Administration for the reduction of uric acid. Rasburicase is a recombinant urate oxidase enzyme that converts uric acid to allantoin, which has increased urine solubility. It is administered intravenously once-daily and leads to rapid, dramatic declines in serum uric acid values. The toxicity profile is excellent, with rare incidence of bronchospasm and allergies and a known contraindication for patients with glucose-6-phosphate dehydrogenase deficiency. A Phase III trial in high-risk pediatric patients conclusively demonstrated that rasburicase is more effective than allopurinol in controlling uric acid. Ongoing evidence is accumulating suggesting that the drug is also safe and effective in adults with hematological malignancies.