Antineoplastics/thalidomide
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Reactions 1422 - 6 Oct 2012 S Antineoplastics/thalidomide Tumour lysis syndrome: 2 case reports Two patients with light chain multiple myeloma developed tumour lysis syndrome (TLS) during treatment with thalidomide, dexamethasone, doxorubicin [adriamycin] and vincristine [routes not stated; not all dosages stated]. A 44-year-old man began receiving thalidomide 100mg and dexamethasone 40mg per day in conjunction with radiotherapy to the spine. He subsequently developed insomnia. After 4 days of treatment, laboratory investigations included the following: BUN 69 mg/dL, creatinine 3.22 mg/dL, sodium 127 mEq/L, potassium 6.9 mEq/L, calcium 9.1 mg/dL, phosphate 6.9 mg/dL and uric acid 8.4 mg/day. Due to suspected TLS, he was treated with fluids, glucose, insulin, furosemide, allopurinol and calcium polystyrene sulfonate. After 48h, laboratory tests revealed the following: BUN 43 mg/dL, creatinine 2.51 mg/dL, sodium 131 mEq/L, potassium 3.9 mEq/L, calcium 8.2 mg/dL, phosphate 4.3 mg/dL and uric acid 6.7 mg/dL. He received further treatment courses with thalidomide and dexamethasone, and no TLS was observed. He remained in remission at last follow-up. A 58-year-old woman started receiving dexamethasone, doxorubicin and vincristine. She subsequently developed mild anorexia. On day 3 of chemotherapy, laboratory investigations included the following: BUN 88 mg/dL, creatinine 8.8 mg/dL, sodium 115 mEq/L, potassium 4.9 mEq/L, calcium 7.5 mEq/L, phosphate 9.4 mg/dL and uric acid 8.8 mg/dL. TLS was suspected, and she received fluids, furosemide and allopurinol. Due to oliguria, haemodialysis was initiated. After 2 sessions, laboratory tests revealed the following: BUN 60 mg/dL, creatinine 8.03 mg/dL, sodium 126 mEq/L, potassium 3.5 mEq/L, calcium 7.2 mg/dL, phosphate 6.5 mg/dL and uric acid 5.6 mg/dL. She was transferred to another hospital for maintenance dialysis. Author comment: "In multiple myeloma, TLS may occur after various treatment modalities including monotherapy with bortezomib, steroids and thalidomide, raising concerns about TLS during myeloma treatment." Chang H, et al. Tumor lysis syndrome in patients with light chain multiple myeloma: report of two cases. Chang Gung Medical Journal 34 (Suppl.): 70-5, No. 6, Jan 2011 - Taiwan 803078127 1 Reactions 6 Oct 2012 No. 1422 0114-9954/10/1422-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics/thalidomide
Reactions 1422 - 6 Oct 2012
SAntineoplastics/thalidomide
Tumour lysis syndrome: 2 case reportsTwo patients with light chain multiple myeloma
developed tumour lysis syndrome (TLS) during treatmentwith thalidomide, dexamethasone, doxorubicin[adriamycin] and vincristine [routes not stated; not alldosages stated].
A 44-year-old man began receiving thalidomide 100mgand dexamethasone 40mg per day in conjunction withradiotherapy to the spine. He subsequently developedinsomnia. After 4 days of treatment, laboratoryinvestigations included the following: BUN 69 mg/dL,creatinine 3.22 mg/dL, sodium 127 mEq/L, potassium6.9 mEq/L, calcium 9.1 mg/dL, phosphate 6.9 mg/dL anduric acid 8.4 mg/day. Due to suspected TLS, he was treatedwith fluids, glucose, insulin, furosemide, allopurinol andcalcium polystyrene sulfonate. After 48h, laboratory testsrevealed the following: BUN 43 mg/dL, creatinine2.51 mg/dL, sodium 131 mEq/L, potassium 3.9 mEq/L,calcium 8.2 mg/dL, phosphate 4.3 mg/dL and uric acid6.7 mg/dL. He received further treatment courses withthalidomide and dexamethasone, and no TLS wasobserved. He remained in remission at last follow-up.
A 58-year-old woman started receiving dexamethasone,doxorubicin and vincristine. She subsequently developedmild anorexia. On day 3 of chemotherapy, laboratoryinvestigations included the following: BUN 88 mg/dL,creatinine 8.8 mg/dL, sodium 115 mEq/L, potassium4.9 mEq/L, calcium 7.5 mEq/L, phosphate 9.4 mg/dL anduric acid 8.8 mg/dL. TLS was suspected, and she receivedfluids, furosemide and allopurinol. Due to oliguria,haemodialysis was initiated. After 2 sessions, laboratorytests revealed the following: BUN 60 mg/dL, creatinine8.03 mg/dL, sodium 126 mEq/L, potassium 3.5 mEq/L,calcium 7.2 mg/dL, phosphate 6.5 mg/dL and uric acid5.6 mg/dL. She was transferred to another hospital formaintenance dialysis.
Author comment: "In multiple myeloma, TLS may occurafter various treatment modalities including monotherapywith bortezomib, steroids and thalidomide, raising concernsabout TLS during myeloma treatment."Chang H, et al. Tumor lysis syndrome in patients with light chain multiplemyeloma: report of two cases. Chang Gung Medical Journal 34 (Suppl.): 70-5, No.6, Jan 2011 - Taiwan 803078127
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Reactions 6 Oct 2012 No. 14220114-9954/10/1422-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
