Tumor Lysis Syndrome (TLS)
Case Study Video 1: Tommy
Learn about Tommy, an 8-year-old boy with acute myeloid leukemia (AML) and intermediate
risk for developing tumor lysis syndrome (TLS). Use of ELITEK® allowed
Tommy to receive chemotherapy for his AML without interruption.
Video Transcript
One patient case of interest is one that involves an 8-year-old boy. We’ll call
him Tommy.
When I first saw Tommy, he presented with a history of fevers, weight loss, bleeding
under his skin as well as in the mouth, mucosa, and pallor. The patient had been
in excellent health up until 2 weeks before his admission, at which point he developed
signs of skin petachiae, decreased appetite, intermittent fevers, and decreased
energy.
Upon examination, the patient showed significant and widespread petachiae and pallor.
He also presented with evidence of splenomegaly and abdominal distention. We conducted
a thorough laboratory investigation which revealed a white blood cell count of 25,000,
hemoglobin of 4.6 g/dL, and a platelet count of 4,000. The white blood cell differential
showed 20% myeloblasts, 10% myelocytes, 30% lymphocytes, 10% monocytes, and 30%
neutrophils. Serum chemistries showed a uric acid level of 7.5, phosphate was 11.0,
potassium was 4.6, serum creatinine was 2.6, and LDH was 880.
Due to the nature of Tommy’s symptoms, a bone marrow aspirate and biopsy were performed.
Results revealed a bone marrow picture consistent with acute myeloid leukemia. And
we wanted to start chemotherapy promptly.
His cancer diagnosis combined with his white blood cell count and uric acid level
put him at a potential—or intermediate— risk for tumor lysis syndrome (TLS). Due
to the nature of his TLS risk, we started him on hydration with IV saline along
with ELITEK for uric acid reduction and aluminum hydroxide (as Amphogel).
We conducted frequent serum monitoring and initiated chemotherapy with Ara-C and
doxorubicin. After just 4 hours, the serum chemistry tests demonstrated a uric acid
level of 1.8, while phosphate was 7.2, potassium was 4.8, and creatinine was 1.6.
On Day 2, Tommy’s uric acid level was 2.0, phosphate was 6.1, potassium was 4.6,
and creatinine was 1.2. On Day 3, the uric acid was reduced to 1.9, phosphate was
4.6, potassium was 4.1, and creatinine was 0.7. All chemistries demonstrated reductions
from baseline, most notably, uric acid, which exhibited a 75% reduction from baseline.
In this case, the risks for tumor lysis syndrome (TLS) were mitigated right from
the start, and chemotherapy continued, uninterrupted.
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(Case 1)