Atchison Douglas K, Humes H David
University of Michigan Health System, Department of Internal Medicine, Division of Nephrology, A. Alfred Taubman Health Care Center, Ann Arbor, MI, USA.
Clin Nephrol Case Stud. 2017 Nov 22;5:78-81. doi: 10.5414/CNCS109165. eCollection 2017.
Renal dysfunction is a common comorbidity of multiple myeloma. However, tumor lysis syndrome is a rare cause of renal dysfunction in multiple myeloma. Elotuzumab is a newly US FDA-approved monoclonal antibody used in the treatment of refractory multiple myeloma. To our knowledge, elotuzumab has not been associated with a case of tumor lysis syndrome. We present the case of a patient who developed clinical tumor lysis syndrome 1 week after treatment with elotuzumab accompanied by renal failure with hyperphosphatemia, hyperkalemia, and profound hyperuricemia. His course was further complicated by significant epistaxis from the accumulation of dabigatran in acute renal failure. In spite of treatment with rasburicase and hemodiafiltration, the patient decompensated and eventually died. Risk factors for the development of tumor lysis syndrome in multiple myeloma are discussed.
肾功能不全是多发性骨髓瘤常见的合并症。然而，肿瘤溶解综合征是多发性骨髓瘤导致肾功能不全的罕见原因。埃罗妥珠单抗是美国食品药品监督管理局新批准用于治疗难治性多发性骨髓瘤的单克隆抗体。据我们所知，尚未有埃罗妥珠单抗引发肿瘤溶解综合征的病例报道。我们报告一例患者，其在接受埃罗妥珠单抗治疗1周后出现临床肿瘤溶解综合征，并伴有肾衰竭、高磷血症、高钾血症和严重高尿酸血症。急性肾衰竭时达比加群蓄积导致严重鼻出血，使他的病情更加复杂。尽管接受了拉布立酶和血液透析滤过治疗，患者仍病情恶化，最终死亡。本文还讨论了多发性骨髓瘤发生肿瘤溶解综合征的危险因素。
