Chang Hung, Lee Shen-Yang, Tang Tzung-Chih
Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2011;34(6 Suppl):70-5.
Tumor lysis syndrome (TLS) is a severe life-threatening complication which typically occurs in highly proliferative malignancies, such as Burkitt's lymphoma, acute leukemia or germ cell tumors. Although TLS is unusual in multiple myeloma, it should not be overlooked as it is associated with significant morbidity. In recent years, emerging new agents such as thalidomide and bortezomib have been found to be highly effective in the treatment of multiple myeloma. In this milieu, there is greater concern that the rate of TLS in multiple myeloma will increase. We herein report 2 patients with light chain multiple myeloma who developed TLS during treatment. One patient improved after hydration, allopurinol and forced diuresis. The other underwent hemodialysis because of oliguria. These 2 patients did not have heavy tumor burdens. They also lacked risk factors of TLS that were described in previous reports. Our experience suggests light chain myeloma with underlying myeloma kidney is associated with a risk of TLS. Clinical awareness, close monitoring and early intervention are the keystones in the management of these patients.
肿瘤溶解综合征（TLS）是一种严重的、危及生命的并发症，通常发生于高增殖性恶性肿瘤，如伯基特淋巴瘤、急性白血病或生殖细胞肿瘤。虽然TLS在多发性骨髓瘤中并不常见，但因其与显著的发病率相关，故不应被忽视。近年来，已发现沙利度胺和硼替佐米等新型药物在治疗多发性骨髓瘤方面非常有效。在这种情况下，人们更加担心多发性骨髓瘤中TLS的发生率会增加。我们在此报告2例轻链多发性骨髓瘤患者在治疗期间发生了TLS。1例患者经补液、别嘌醇和强制利尿后病情好转。另1例因少尿而接受了血液透析。这2例患者的肿瘤负荷并不重。他们也缺乏先前报告中描述的TLS危险因素。我们的经验表明，伴有潜在骨髓瘤肾病的轻链骨髓瘤与TLS风险相关。临床意识、密切监测和早期干预是这些患者管理的关键。
