Acute Tumor Lysis Syndrome Research Articles

Acute Tumour Lysis Syndrome associated with mediastinal lymphoma in a dog

An eleven-year-old non-descript female dog weighing about 27 kg presented to small animal clinical complex was diagnosed with lymphoma (Stage IV) based on the clinical signs, serum biochemistry, radiography, ultrasonographical examination and histopathological examination of FNAC sample taken from superficial lymph nodes. The University of Wisconsin -Madison Lymphoma CHOP-19 protocol was initiated on day one with vincristine and prednisolone acetate. On day three dog was presented with signs of dyspnoea, vomiting and generalized edema. Metabolic acidosis, hyperphosphatemia, hyperkalemia, hyperchloremia, azotemia were observed. These abnormalities led to a tentative diagnosis of acute tumor lysis syndrome (ATLS). Aggressive Fluid therapy and other supportive therapy was initiated but the animal died due to multiple organ failure.

Acute tumor lysis syndrome — an urgent multidisciplinary problem in pediatric hematology

Acute tumor lysis syndrome — an urgent multidisciplinary problem in pediatric hematology

Analysis of acute leukemia complications in children at the disease onset and during induction

Background. Despite the progress achieved in the treatment of acute leukemia (AL) in children, complications, both at the disease onset and those resulting from antitumor therapy, remain the main cause of early mortality, which varies from 3 to 20 %.Aim. To assess the frequency, severity, etiology, risk factors, and outcomes of AL complications in children at the disease onset and during induction chemotherapy (ICT).Results. The study analyzed 92 cases of AL in children aged from 5 months to 17 years. 75 patients had acute lymphoblastic leukemia (ALL), 17 had acute myeloid leukemia (AML). In 1 (1.3 %) patient with ALL and in 5 (29.4 %) with AML, a concomitant diagnosis was Down syndrome. At the AL onset, 34 (36.9 %) patients were diagnosed with infection, of which 27 (36 %) and 7 (41.2 %) patients had ALL and AML, respectively. In both cohorts, febrile neutropenia (55.5 %; n = 15 vs. 14.3 %; n = 1), pneumonia (25.9 %; n = 7 vs. 71.4 %; n = 5), enterocolitis (7.4 %; n = 2 vs. 14.3 %; n = 1) predominated in both cohorts for AML and ALL, respectively. Due to uncontrolled infection in 5 (29.4 %) patients with AML and 13 (17.3 %) with ALL, ICT was delayed until the condition stabilized and the infection was controlled. During ICT, the incidence of infectious complications was 81.3 % (n = 61) and 100 % (n = 17) in patients with ALL and AML, respectively. The most common types were enterocolitis (41.2 %; n = 7 vs. 34.4 %; n = 21), febrile neutropenia (29.4 %; n = 5 vs. 37.7 %; n = 23), pneumonia (47.1 %; n = 8 vs. 29.5 %; n = 18), catheter-associated bloodstream infection (11.8 %; n = 2 vs. 8.2 %; n = 4) in AML and ALL, respectively. By etiology, bacterial infections predominated, accounting for 32 % (n = 8) and 36.8 % (n = 35) in the AML and ALL groups, respectively. More cases of invasive mycoses were reported in AML patients – 23.5 % (n = 4) versus 14.8 % (n = 11). Non-infectious complications were diagnosed in 32.6 % (n = 30) of patients with a predominance in ALL group (34.6 %; n = 26 vs. 23.5 %; n = 4). Hyperleukocytosis at the leukemia onset caused such complications as leukostasis (11.8 %; n = 2) and acute tumor lysis syndrome (11.8 %; n = 2). The most common post-cytostatic complications in ALL were vincristine polyneuropathy (61.5 %; n = 16), hemorrhagic syndrome (15.4 %; n = 4), methotrexate-induced encephalopathy (15.4 %; n = 4), acute tumor lysis syndrome (11.5 %; n = 3). In AML cases, the most common type of non-infectious complications were hemorrhagic (75 %; n = 3). Induction mortality in the ALL group was 2.6 % (n = 2), in the AML group it was higher – 11.8 % (n = 2), however, it should be noted that all deaths were registered in children with Down syndrome. The main cause of mortality in both groups was severe infections secondary to chemotherapy-induced hematopoietic aplasia. There were no deaths associated with non-infectious complications or chemotherapy-induced toxicity.Conclusion. The main type of toxicity in children at the AL onset and during ICT remains infectious complications of various etiologies, while in AML patients a higher frequency of invasive mycoses is registered (23.5 % vs. 14.8 %). Despite the high incidence of chemo-induced toxicity, the mortality rate in ALL remains low, amounting to 2.6 % in our cohort. In the AML group, mortality was higher – 11.8 %, but it should be noted that all cases occurred in patients with Down syndrome. There were no deaths due to non-infectious complications in any of the study cohorts.

R-CHOP Versus CHOP-R: Influence of Rituximab Timing on Real-World Outcomes in Patients with Diffuse Large B Cell Lymphoma

Diffuse large B cell lymphoma (DLBCL) is the most common aggressive lymphoma and is conventionally treated with the chemotherapy regimen R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). The major clinical trials of R-CHOP administered rituximab on the same day as CHOP chemotherapy (R-CHOP). However, in real-world community oncology settings physicians often delay rituximab treatment until after chemotherapy is complete (CHOP-R). This is due to both concerns about drug reimbursement rates in the hospital versus outpatient setting and toxicity considerations. In particular, there is anecdotal evidence and limited retrospective data (Hannawa et al, J Oncol Pharm Pract 2011) that infusion reactions with rituximab may be lessened if rituximab administration is delayed until after CHOP chemotherapy. The current study aims to compare the incidence of infusion reactions, tumor lysis syndrome (TLS), and treatment efficacy in a retrospective cohort of DLBCL patients who received rituximab administration before chemotherapy (R-CHOP) versus those who received it after chemotherapy (CHOP-R). In the current study, we reviewed 178 adult patients with DLBCL who received R-CHOP or CHOP-R between 9/1/2011 and 9/1/2021 at our institution. Treatment groups were defined based on the treatment received during the first cycle of chemotherapy. Patients were identified and data was extracted from electronic health records using Epic's SlicerDicer tool and integrated with data from manual chart review. A two-tailed Fisher's exact test with a significance level of 0.05 was used to analyze 2x2 tables describing the incidence of infusion reactions and tumor lysis syndrome. The study cohort consisted of 178 patients including 139 patients (78%) in R-CHOP group and 39 patients (22%) in CHOP-R group. The median age at diagnosis was 65 years (range 22-92) in the R-CHOP group and 72 years (range 29-86) in the CHOP-R group. The R-CHOP group was approximately evenly split between female (51%) and male (49%), however the CHOP-R group was mostly male (69%). Double hit status was known in 96 patients (3 patients positive and 93 patients negative) in the R-CHOP group and 34 patients (4 patients positive and 30 patients negative) in the CHOP-R group. More patients in CHOP-R group had stage III/IV lymphoma (82%) as compared to the R-CHOP group (61%). HIV associated lymphoma at the time of diagnosis was reported in 3 patients in R-CHOP group vs 1 patient in CHOP-R. Median rituximab -containing cycles received in R-CHOP group were 6 (range 1-6) and CHOP-R group were 5 (range 1-6). We examined the incidence of acute infusion reactions within 24 hours of rituximab administration during the first cycle of chemotherapy. Symptoms/signs of infusion reactions that we examined included fever, chills, rigors, hypotension, hypertension, hypoxia and tachycardia. Patients who did not have adequate data available were excluded from analysis. A total of 29% of patients in the R-CHOP group experienced any infusion reaction as compared to 21% of patients in the CHOP-R group. Data on the incidence of TLS, defined as per the Cairo-Bishop criteria, was collected. Patients who had limited laboratory data available were excluded from analysis. A total of 12% of patients in the R-CHOP group experienced TLS as compared to 17% in the CHOP-R group (p=0.52). Most TLS was present prior to the initiation of treatment. In conclusion, our study found no statistically significant difference in the incidence of acute infusion reactions or tumor lysis syndrome when rituximab administration is delayed. Data on efficacy and survival outcomes will be presented.

Current trends in the diagnosis and treatment of acute tumor lysis syndrome in children: a review

INTRODUCTION: Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemia, lymphomas in children and is accompanied by a fatal outcome in 21.4 % of patients. The basis of ATLS is the decay of tumor cells, in which the volume of decay products exceeds the excretory capabilities of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100×109/L) and non-Hodgkin's lymphomas with a large tumor mass (III–IV stages of the disease). To date, the volume of thematic publications in the aggregator of the PubMed medical database is not so large: over the past 10 years, there have been 12 articles, which makes the task of systematizing previously accumulated and recently received information even more relevant for the practitioner. OBJECTIVE: Generalization of the modern scientific base for the diagnosis and treatment of ATLS in children. MATERIALS AND METHODS: To highlight the modern scientific base concerning the diagnosis and treatment of ATLS in children with oncohematological diseases, a search was conducted in PubMed, Research Gate, Web of Science Core Collection and Google Scholar systems for the period from 2000 to August 2022. RESULTS: In total, 94 articles were found, including 1 systematic review with meta-analysis and 16 review articles that meet the requirements. CONCLUSIONS: Conservative ATLS prophylaxis is effective in 93.4–93.6 % of patients. However, in 8.8–21.4 % of patients, ATLS acquires a rapid character, accompanied by the lack of the ability to conservatively correct the indicators of potassium, phosphorus, uric acid. Additional study of the pathogenetic mechanisms of the complication, identification of key targets of drug therapy and a multidisciplinary approach in the treatment of an extremely prognostically unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components of further improving the effectiveness of ATLS therapy.

Tumour lysis syndrome: modern aspects of the problem

Background. Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemias and lymphomas in children and leads to death in 21.4 % of severe cases. ATLS is based on the death of tumor cells, so the volume of decay products exceeds the excretory capacity of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100 × 109/L) and non-Hodgkin’s lymphomas with a large tumor mass (stage III–Iv of the disease). The development of acute renal and then multiple organ failure require intensive monitoring of ATLS clinical and biochemical markers and the development of optimal patient management tactics jointly by an intensive care physician and a pediatric oncologist-hematologist.Aim. To summarize the literature and our own clinical experience in the diagnosis and treatment of ATLS in pediatric oncohematology.Materials and methods. The literature data on the diagnosis and treatment of ATLS in children with oncohematological diseases were analyzed. Summarized own clinical experience from January 2009 to January 2022.Results. Of 379 patients with acute lymphoblastic leukemia and non-Hodgkin’s lymphomas, who are at risk for developing ATLS, 350 (93.4 %) patients underwent conservative ATLS therapy, of which in 31 (8.8 %) cases, hemodiafiltration was required to eliminate tumor decay products. The average number of hemodiafiltration procedures is 3 (from 1 to 15). Nevertheless, despite the whole range of therapeutic measures, the addition of infectious and multiple organ complications caused death in 7 (22.6 %) of 31 patients. Most (5 out of 7) fatal cases occurred between 2009 and 2013, and the number of lethal cases because of ATLS from 2014 to 2022 years were only 2. In 24 (77.4 %) patients, the signs of ATLS were successfully managed, the patients continued antitumor treatment. when observing patients for 6 years (from 7 months to 13 years), there were no signs of disease relapse, as well as renal dysfunction.Conclusion. prevention and treatment of ATLS, including cytoreductive prephase, infusion therapy, allopurinol and rasburicase, and in case of ineffectiveness, hemodiafiltration is the basis of modern intensive therapy for hematological malignancies in children. Additional study of the pathogenetic mechanisms of ATLS development, identification of key targets of drug therapy, and a multidisciplinary approach in the treatment of an extremely unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components for further increasing the effectiveness of ATLS therapy.

Acute Tumor Lysis Syndrome: A Review of 100 Patients with Acute Lymphoblastic Leukemia

Background: ALL is a malignancy of B or T lymphoblasts which is characterized by unrestrained spread of abnormal, immature lymphocytes and their progenitors which results in the replacement of bone marrow and other lymphoid organs subsequently. Methods: This study was a observational cross sectional study conducted at the Department of Hematology, in Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh. The study period was from October 2019- September 2020. The sample size for this study was 100. Result: Most of the respondents 53(53%) were from <20 years and the mean age was 30±11.18. The female was 68(68%) and male was 32(32%). Fever was found in 100% cases and Progressive pallor in 98%. Bony tenderness was found in 58 cases and followed by Splenomegaly 48, Lymphadenopathy in 46, Oral ulcer in 46, Hepatomegaly in 36. The range of Total WBC count (x109/L) was (6-435) and the Mean±SD was 52.51±78.70 and followed by Hb% (gm/dl) was (4.1-13.4) and 9.25±1.49, Platelet (x109/L) was (5-20000) and 505.20±2815.29. S. uric acid (mg/dL) was (1.40-30.03) and 5.76±4.61. S. inorganic phosphate (mg/dL) was (2.30-7.70) and 4.19±1.20. S. potassium (mmol/L) (2.50-5.40) and 3.92±0.56. S. calcium (mg/dL) was (1.10-11.80) and 8.33±2.08. S. creatinine (mg/dL) was (0.19-3.59) and 89±0.55. In 72% TLS was absent and in 28% was present. Conclusions: Rapid spread of TLS often causes severe toxic effects on organs, which leads to renal impairment, epilepsy, cardiac arrhythmias, pulmonary edema, and even death.

ИНТЕНСИВНАЯ ТЕРАПИЯ ЖИЗНЕУГРОЖАЮЩИХ СОСТОЯНИЙ В ДЕТСКОЙ ОНКОГЕМАТОЛОГИИ

Malignant neoplasms of the blood system in children are represented by highly aggressive variants, which at the stage of diagnosis and program chemotherapy can be complicated by the development of life-threatening conditions. Understanding the risk of possible complications allows you to effectively carry out preventive and therapeutic measures, to minimize adverse outcomes. This article presents modern approaches to the diagnosis and treatment of the most common life-threatening conditions in pediatric oncohematology: acute tumor lysis syndrome, typhlitis and neutropenic enterocolitis, superior vena cava syndrome, malignant airway compression syndrome, acute impairment of consciousness, spinal cord compression syndrome, thrombosis, methemoglobinemia.

Acute Tumor Lysis Syndrome: A Metabolic Emergency in Cancer Patients

Tumor lysis syndrome (TLS) can be a life-threatening complication that occurs following the onset of chemotherapy treatment, most commonly in association with high-grade lymphoproliferative pathologies such as acute lymphoblastic leukemia and Burkitt lymphoma. The massive cell lysis caused by cytotoxic therapy leads to the rapid release in the blood of intracelullary products and the onset of severe metabolic and electrolytic complications (hyperkalemia, hyperphosphatemia, hypocalcemia and hyperuricemia) upto the acute renal failure. This article describes the incidence and pathophysiological basis of TLS, focusing on the new therapeutic strategies implemented over the last few years, especially with regard to the treatment of hyperuricemia. In particular, it highlights the characteristics of a recent drug, Rasburicase, as a safe and effective alternative, compared to traditional allopurinol therapy, for prophylaxis and treatment of children with hyperuricemia induced by chemotherapy.

Transient Hyperammonemic Encephalopathy in a Child with Relapsed Acute Lymphoblastic Leukemia and Severe Tumor Lysis Syndrome

AbstractIdiopathic hyperammonemia (IHA) is a severe condition, which has been reported in intensive chemotherapy and bone marrow transplantation. This case elucidates the diagnostic dilemma in children undergoing initiation of chemotherapy and developing severe disorders of qualitative and quantitative consciousness in the presence of hyperammonemia (HA) and lactic acidosis. The role of mitoxantrone as a causative agent for IHA in children is elusive. Children undergoing chemotherapy are often in a poor general condition, and the clinical presentation of HA is heterogeneous. This case should be a reminder for clinicians to check for HA in children with tumor lysis syndrome and acute neurological deterioration.

A new childhood ALL case with an extremely complex karyotype and acute spontaneous tumor lysis syndrome

BackgroundB cell precursor acute lymphoblastic leukemia (B-ALL) is the most common malignancy of childhood, with, after corresponding treatment, an overall complete remission rate of 90%. Approximately 75% of B-ALL cases harbor recurrent abnormalities, including so-called complex karyotypes (CK). Tumor lysis syndrome (TLS) is a metabolic abnormality which may arise during cancer therapy and also, extremely rarely, as spontaneous TLS before initiation of chemotherapy in patients with ALL.Case presentationHere we report a 9-year-old male, diagnosed with a de novo pre-B-ALL according to the WHO classification. Cytogenetic, molecular cytogenetic approaches and array comparative genomic hybridization analyses revealed a unique CK involving five chromosomes. It included four yet unreported chromosomal aberrations: a der(11)t(7;11)(p22.1;q24.2), a der(18)t(7;18)(q21.3;p11.22), del(11)(q24.2q25) and dup(18)(q11.1q23). Unfortunately, the patient died 3 months after the initial diagnosis.ConclusionsTo the best of our knowledge, a comparable childhood ALL case was not previously reported. Thus, the combination of the here seen chromosomal aberrations in childhood primary ALL seems to indicate for an extremely adverse prognosis.

Hyperleucocytosis in children with acute mieloid leukemia

This article presents analysis of recent publications on hyperleukocytosis in children with AML. The mechanisms of the development of life-threatening complications accompanying hyperleukocytosis are analyzed in detail. In this review of the literature, the authors focus on the adequacy and timing of therapy for such life-threatening complications of hyperleukocytosis as leukostasis, DIC, and acute tumor lysis syndrome. The authors emphasize that in the treatment of hyperleukocytosis an important place, in addition to specific therapy, is taken by the accompanying therapy in the intensive care unit. The place of replacement blood transfusions and leukopheresis as part of the accompanying therapy is discussed.

Rapid Dose Escalation of Venetoclax in Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia Previously Treated with B-Cell Receptor Inhibitor Therapy

Rapid Dose Escalation of Venetoclax in Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia Previously Treated with B-Cell Receptor Inhibitor Therapy

Replace “Have to” With “Want to”

Replace “Have to” With “Want to”

Fatal peripheral T-cell lymphoma presenting as hypereosinophilia and spontaneous tumor lysis syndrome: A rare case report

Peripheral T-cell lymphomas (TCLs) are a heterogeneous group of aggressive, uncommon forms of T-cell or natural killer cell-derived non-Hodgkin's lymphomas. Acute tumor lysis syndrome (TLS) is a multiple metabolic derangement that occurs due to the treatment of malignancies or spontaneous tumor cell death. We report the case of a 56-year-old male patient who presented with marked eosinophilic leukocytosis, rash, and lymphadenopathy at the initial visit but finally manifested with TCL and spontaneous TLS. On the first visit, hemogram showed a marked eosinophilic leukocytosis and raised lactate dehydrogenase. The patient refused for admission; however, lymph node biopsy was done on day-care basis. After 3 days, the patient presented in the emergency room with shortness of breath, altered renal and liver parameters, and dyselectrolytemia. Based on histopathological with immunohistochemistry findings on lymph node biopsy and clinical and laboratory finding, the patient was diagnosed as TCL-not otherwise specified with TLS.

Clinical prognosis and basics of anti-neoplastic therapy

The histopathological examination can be completed by immunohisto(cyto)chemical examination, cytometry or molecular techniques, what allows to determine the statistical probability of metastasis. It improves the patient’s qualification to appropriate individual treatment that can be most effective with fewer side effects. The basis of neoplastic treatment, including multidrug resistance (MDR) was described. I characterize the role of transporters (molecular pumps, e.g. ABC - ATP-binding cassettes, RND, SMR, MFS and P450 – CYP), complication of neoplastic therapy (e.g. myelosuppression, acute tumor lysis syndrome) and minimal residual disease (MRD).

Clinical pathologic characteristics and treatment outcomes of 19 relapsed pediatric B-cell lymphoma

Objective: To review the clinical-pathology characteristics of 19 relapsed pediatric mature B cell lymphoma and to find the risk factors for recurrence and the feasible treatment after relapse. Method: Data of 212 pediatric B cell lymphomas cases in Beijing Children's Hospital from January 2006 to June 2015 were collected retrospectively. All the patients were treated according to the B cell lymphoma regimen of Beijing Children's Hospital. During the study period, 19 of 212 cases were relapsed; the clinio-pathological characteristics of relapsed patients before treatment and after relapse were analyzed retrospectively, the treatment outcomes after relapse were summarized and the patients were followed-up. Result: Nineteen of 212 cases had relapsed disease, for these relapsed patients: the median age at initial diagnosis was 5.5 years old, the median level of uric acid was 384(range, 121-713)μmol/L, the median level of lactate dehydrogenase(LDH) was 1 323(range, 146-6 370)U/L. Among 19 relapsed patients, 10 had local relapse and 9 had multiple relapses; 17 were Burkitt's lymphoma and 2 were diffuse large B cell lymphoma. Staging: 2 cases were stageⅡ, 3 cases were stage Ⅲ and 14 cases were stage Ⅳ. Risk group: 6 cases were group B and 13 cases were group C. Nine cases had bone marrow involvement and 10 cases had central nervous system(CNS) involvement. Acute tumor lysis syndrome was seen in 6 cases during the early treatment and 13 cases had delayed treatment. Treatment after relapse: 10 cases received further treatment after relapse (rituximab + 1-4 courses high intensity second-line chemotherapy), 3 cases received autologous stem cell transplantation. There was no chemotherapy or infection related death, 3 cases achieved complete remission (CR). For all the 212 patients, the median follow-up time was 47 (range, 1-131)months and the 5-year event free survival(EFS)rate was (89.4±0.2)%. For the 19 relapse cases, the 5-year overall survival (OS) rate was (21.1±0.1)%, CR rate after relapse was 30%, patients died of the progression of the primary disease, no treatment related death occurred. Univariate analyses showed that bulky disease, stage Ⅳ, maxillofacial and CNS involvement, LDH>1 000 U/L, delay treatment, day 7 evaluation shrink <25%, residual diseases after 3 months treatment are relapse risk factors (all P<0.01). Conclusion: Patients relapse during the treatment or at the early stage after the end of all chemotherapy have poor prognosis. So far there is no effective method for early relapse patients; the late relapse patients had the possibility of CR if they are sensitive to salvage treatment. In conclusion, to improve the outcome, the key point is to reduce the relapse.

Young donor white blood cell immunotherapy induces extensive tumor necrosis in advanced-stage solid tumors

BackgroundIn the past decade, a variety of immunotherapy approaches focused predominantly on the adaptive immune system have shown unprecedented responses in patients with advanced-stage malignancies. However, studies in spontaneous regression/complete resistance (SR/CR) mice and humans have shown a novel innate cancer-killing activity mediated by granulocytes, which is completely transferable for prevention or therapy against established malignancies. MethodsThree patients with advanced, relapsed or refractory solid tumors for which no standard therapy was available or was refused were enrolled into this ongoing combined phase I/II open label clinical trial testing the safety, dose tolerance, and possible antineoplastic efficacy of sequential infusions of HLA-mismatched non-irradiated allogeneic white cells (68–91% granulocytes) collected by leukapheresis from young, healthy donors (age 18–35) following mobilization with granulocyte colony stimulating factor (G-CSF) and dexamethasone. ResultsBesides fevers and flushing, no infusional toxicities were observed. All patients remained clinically stable following infusions with mild cytokine release syndrome and no evidence of transfusion-associated graft-versus-host disease, acute tumor lysis syndrome,or transfusion-associated acute lung injury. Pathological examination of all cases post-mortem revealed extensive tumor necrosis up to 80% in patients 1–2, 40–50% in patient 3, and leukocyte infiltration in all cases, which could not be attributed to disease progression. ConclusionsAllogeneic white cell immunotherapy (AWIT) from young, healthy donors is well tolerated with minimal side effects and shows antitumor activity against advanced-stage solid tumors. AWIT represents a novel, safe, and cost-effective immunotherapy that can be administered in an outpatient cancer clinic.

Acute Tumor Lysis Syndrome after Cisplatin and Gemcitabine for Treatment of Urothelial Carcinoma of the Renal Pelvis: Case Report and Review of Literature

Tumor lysis syndrome (TLS) is a potentially fatal complication of oncological therapy. It is rarely described in patients with solid tumors, even rare in urological cancer. To the best of our knowledge, there were only two cases describing TLS following chemotherapy for metastatic urothelial carcinoma documented in the literature, although only one occurred after gemcitabine, another case occurred after PD-1 Immunotherapy. Case presentation: We present the case of a 67-year-old female who developed acute renal failure and tumor lysis syndrome after a single infusion of cisplatin and gemcitabine for metastatic renal pelvic urothelial carcinoma. Conclusions: Patients with urothelial carcinoma that are highly proliferative and have high tumor burden are at high risk of developing hyperuricemia and TLS, while undergoing chemotherapy. Although TLS is rare in solid tumor, oncologists should be alert when treating patients at high risk of TLS, and determine appropriate prophylaxis. We also proposed biomarker based risk stratification for patients with high risk for TLS.

Acute tumor lysis syndrome after anti-pd-1 immunotherapy nivolumab for metastatic melanoma.

A 76 -year-old male with history of multifocal melanoma involving maxillary and left nostril (T3NxM0) diagnosed in June 2015, who was treated at outside hospital with resection and adjuvant XRT. One year after initial diagnosis, he presented to our hospital with 20 lb weight loss, fatigue and abdominal bloating. A computerized tomography (CT) scan of the chest abdomen and pelvis with and without IV contrast revealed widely metastatic disease involving lung, liver, kidneys, omentum, adrenal, bones