Abstract
BackgroundNovel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma. Although multiple myeloma is a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. Previous studies, mostly case reports or case series, have reported bortezomib-induced TLS in patients with multiple myeloma. This study aimed to investigate risk factors associated with TLS development in multiple myeloma patients.MethodsWe retrospectively investigated incidences of laboratory and clinical TLS (LTLS and CTLS, respectively) in patients who received primary therapy for treatment-naive, symptomatic multiple myeloma between May 2007 and January 2018. We used multivariate logistic regression analyses to evaluate the associations between TLS and several parameters previously reported to be associated with increased risk.ResultsThis study included 210 patients with multiple myeloma, of which ten (4.8%) had LTLS and seven (3.3%) had CTLS. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between patients with and without TLS. Multivariate analyses revealed that TLS was most strongly associated with bortezomib-containing therapy (odds ratio = 3.40, P = 0.069), followed by male sex (odds ratio = 2.29, P = 0.153). In a subgroup analysis focused on men, treatment with bortezomib-containing therapy was significantly associated with increased risk of TLS (odds ratio = 8.51, P = 0.046).ConclusionIn the present study, we investigated the risk factors associated with TLS development in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date. Furthermore, this study is the first to evaluate TLS risk factors in MM by adjusting for the effects of potential confounding factors in patients’ backgrounds. Consequently, we found that bortezomib-containing therapy increases the risk of TLS in male patients with multiple myeloma. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, since a significant number of novel therapies can achieve high antitumor responses.
Highlights
Novel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma
In the present study, we investigated the risk factors associated with tumor lysis syndrome (TLS) development in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date
We found that bortezomib-containing therapy increases the risk of TLS in male patients with multiple myeloma
Summary
Novel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma. Tumor lysis syndrome (TLS) is a group of metabolic disorders that involve the massive and abrupt release of cellular components into the blood after the lysis of malignant cells. This occurs following the initiation of cancer treatments, which include the administration of anticancer agents. Thereafter, in 2010, TLS was redefined by an international TLS expert panel [3], which excluded laboratory data on abnormalities in serum calcium This definition is one of the most recently reported, which is globally accepted and adopted in some of the clinical guidelines for TLS, including the Japanese guidelines.
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