Acute Tumor Lysis Syndrome during Oral Fludarabine Treatment for Chronic Lymphocytic Leukemia. Role of Treatment with Rasburicase.

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Acute Tumor Lysis Syndrome during Oral Fludarabine Treatment for Chronic

Lymphocytic Leukemia. Role of Treatment with Rasburicase.

Calvo-Villas, Basilio Urcuyo, Adelaida Morales Umpierrez, and

Francisco Sicilia

Onkologie, March 20, 2008; 31(4): 197-199.

Department of Hematology, Hospital General de Lanzarote, Arrecife de Lanzarote,

Spain.

Introduction: 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. Case Report: 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.

PMID: 18418022