Tumor Lysis Syndrome (TLS)
Case Study Video 3: Jenny
Watch Jenny’s story, a 7-year-old girl with Burkitt’s lymphoma and high risk for
developing tumor lysis syndrome (TLS). Use of ELITEK® allowed Jenny
to continue her chemotherapy as scheduled.
Video Transcript
The following is the case of a 7-year-old girl. We can call this patient, Jenny.
When I first met Jenny, she presented with a recent history of abdominal pain, abdominal
distention, constipation, and decreased appetite. She had been well up until about
4 weeks prior to presentation when she noticed a protuberance in her abdomen, decreased
appetite, constipation, and abdominal pain. Her physical examination demonstrated
a distended and tender abdomen, as well as an abdominal mass and inguinal adenopathy.
She had no evidence of hepatosplenomegaly.
Initial laboratory studies demonstrated a normal CBC with a white blood cell count
of 6400, hemoglobin of 11.1 g/dL, and a platelet count of 175,000. Serum chemistries
showed a uric acid level of 8.7, phosphate level of 10.0, potassium level of 4.8,
a creatinine level of 3.0, and an LDH of 3500.
An abdominal ultrasound indicated a large abdominal mass measuring 10 x 12 centimeters,
renal tumor infiltration, and mild splenomegaly. An excisional biopsy was also performed
and the resulting diagnosis was Burkitt’s Lymphoma with typical cytogenetic features,
that is the 8; 14 translocation.
Clinical investigation confirmed she had Burkitt’s lymphoma, and this particular
diagnosis, combined with her serum chemistries, put her at high risk for the development
of tumor lysis syndrome (TLS). In order to initiate chemotherapy as soon as possible,
we first started the patient on hydration to alleviate her TLS risk with IV saline
(3L/m2/day), aluminum hydroxide (as Amphogel), and ELITEK for uric acid reduction
at a dose of 0.2 mg/kg/day x 5 days.
After 4 hours of this therapy, she was then started on cyclophosphamide, vincristine,
and prednisone reduction chemotherapy also known as the COP regimen.
At this point, her chemistry profile demonstrated a uric acid level of 3.2, a phosphate
level of 8.6, a potassium level of 3.6, and a creatinine level of 2.1.
After 24 hours, her chemistry parameters continued to improve and demonstrated a
uric acid level of 1.8, a phosphate level of 6.0, a potassium level of 4.0, and
a creatinine level of 1.6.
And after 48 hours, all chemistries exhibited substantial reductions. Her uric acid
level was 1.0—an 88.6% reduction from baseline—phosphate was 4.2, potassium was
4.1, and creatinine was 1.1.
After multi-agent chemotherapy, LDH, levels decreased from 3500 to 900 in 48 hours—a
74% reduction from baseline.
Jenny continued on her chemotherapy as scheduled.
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(Case 3)