Schuman Samer, Pearson Joseph Matt, Lucci Joseph A, Twiggs Leo B
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami-Miller School of Medicine, Miami, Florida, USA.
J Reprod Med. 2010 Sep-Oct;55(9-10):441-4.
Tumor lysis syndrome (TLS) is an extremely rare complication of solid tumors and is more frequently observed in patients with hematologic malignancies. This report describes a novel approach to the management of a rare case of TLS in metastatic gestational trophoblastic neoplasia (GTN).
A 17-year-old female presented 8 weeks postpartum with severe anemia, thyrotoxicosis, and elevated serum beta-human chorionic gonadotropin (beta-hCG). Imaging studies confirmed metastatic GTN to the lungs. The patient developed grade 4 TLS after the first cycle of etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). She did not respond to standard treatment of aggressive hydration and allupurinol and continued to be in renal failure with elevated uric acid. A single dose of recombinant urate oxidase, rasburicase, rendered the uric acid level undetectable in 3 days and completely reversed the renal failure, avoiding hemodialysis. Three more cycles of EMA-CO were then administered. Subsequently, the patient developed congestive heart failure and was switched to single-agent actinomycin-D. Beta-hCG became negative after 5 cycles, and her ejection fraction returned to baseline.
This is a rare case of TLS in the setting of metastatic GTN. To our knowledge this is the first reported case of utilizing rasburicase for the management of TLS in GTN.
肿瘤溶解综合征（TLS）是实体瘤极为罕见的并发症，在血液系统恶性肿瘤患者中更常见。本报告描述了一种治疗转移性妊娠滋养细胞肿瘤（GTN）中罕见TLS病例的新方法。
一名17岁女性产后8周出现严重贫血、甲状腺毒症及血清β-人绒毛膜促性腺激素（β-hCG）升高。影像学检查证实肺部有转移性GTN。该患者在接受依托泊苷、甲氨蝶呤、放线菌素D、环磷酰胺和长春新碱（EMA-CO）的第一个疗程后发生4级TLS。她对积极补液和别嘌醇的标准治疗无反应，持续处于肾衰竭状态且尿酸升高。单剂量重组尿酸氧化酶拉布立酶在3天内使尿酸水平降至检测不到，并完全逆转了肾衰竭，避免了血液透析。随后又给予了三个疗程的EMA-CO。之后，患者出现充血性心力衰竭，改为单药放线菌素D治疗。5个疗程后β-hCG转阴，射血分数恢复至基线水平。
这是转移性GTN背景下罕见的TLS病例。据我们所知，这是首例报道使用拉布立酶治疗GTN中TLS的病例。
