Tumor Lysis Syndrome (TLS)
Case Study Video 2: John
John, a 14-year-old boy, was diagnosed with T-cell acute lymphoblastic leukemia
and intermediate risk for developing tumor lysis syndrome (TLS). With the use of
ELITEK®, John was able to complete his anti-cancer therapy without
interruption.
Video Transcript
This next case involves a 14-year-old boy who presented with a history of weakness,
lethargy, and shortness of breath. We can call him John.
John’s history indicated that he had been in excellent health up until 1 week before
his hospital admission, at which point he noticed a decreased energy level, lethargy,
and progressive shortness of breath—particularly when lying flat. Upon physical
examination, it was noted that the patient had tachypnea when lying flat, accompanied
by respiratory wheezing. He also showed evidence of cervical and supraclavicular
adenopathy.
After a thorough laboratory investigation, we learned that our patient had a white
blood cell count of 30,000, hemoglobin was 11.1 g/dL, and his platelet count was
80,000. The differential count demonstrated 70% lymphs, 15% lymphoblasts, 10% atypical
lymphs, and 5% neutrophils. Initial serum chemistries revealed a uric acid level
of 6.0, phosphate was 10.0, potassium was 4.1, creatinine was 0.8, and LDH was 2,500.
Due to the nature of the patient’s physical and laboratory findings, which included
lethargy, a lumbar puncture was performed; this showed normal results. A bone marrow
aspirate and biopsy were also conducted suggesting the diagnosis of T-cell acute
lymphoblastic leukemia. A chest x-ray revealed a mediastinal mass 6 by 8 centimeters
in size.
John was diagnosed with T-cell acute lymphoblastic leukemia. His serum chemistry
levels combined with the fact that he had a bulky tumor also put him at an intermediate—or
potential—risk for tumor lysis syndrome (TLS). We wanted to treat his leukemia but
also mitigate his risk for tumor lysis syndrome (TLS) simultaneously.
Induction chemotherapy was started with vincrisine, prednisone, L-asparaginase,
and doxorubicin. In this case, to mitigate the risk of clinical tumor lysis syndrome
(TLS), hydration was initiated with IV saline and the patient was started on aluminum
hydroxide (as Amphogel). ELITEK was also given at 0.2 mg/kg/day and was initially
planned for 5 days for uric acid reduction.
4 hours after initiation of therapy, serum chemistries demonstrated a uric acid
level of 1.1 (an 81.6% reduction from baseline), phosphate was 4.6, potassium was
4.1, and creatinine was 0.8. John completed his anti-cancer therapy without interruption.
Download Transcript
(Case 2)