Calvache Ebellins Tabares, Calvache Allison Dessiret Tabares, Weber Cristiane Seganfredo
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Universidad ICESI, Cali, Colombia.
Hematol Transfus Cell Ther. 2024 Oct-Dec;46(4):340-344. doi: 10.1016/j.htct.2023.02.005. Epub 2023 Apr 11.
The tumor lysis syndrome is a medical emergency. Its presentation can be spontaneous or secondary, as a consequence of the established treatment. The diagnosis and treatment of the tumor lysis syndrome (TLS) has become a crucial goal to the evolution and improvement of treatments and targeted therapies.
Between January 2014 and December 2019, we retrospectively reviewed inpatients aged over 18 years with hematological neoplasms from a tertiary hospital in Brazil. We identified 112 episodes of TLS in 97 patients. The incidence was 10.5% and the median OS was 13.0 months (95%CI 6.2 - 19.7). The median age was 56 years (IQR 39.5 - 64). The most frequent diagnoses were multiple myeloma (18.6%), acute myeloid leukemia (17.5%) and diffuse large B-cell lymphoma (17.5%). All patients received intravenous (IV) hydration. The management also included the administration of allopurinol in 76% of the cases and rasburicase in eight patients. Renal replacement therapy was necessary in 37% of the cases. In the multivariate analysis, age, HIV status and ICU treatment were significantly associated with OS.
The TLS is a serious complication in the setting of hematological malignancies. The use of scores for risk stratification, as well as the inclusion of prophylactic measures and prompt treatment with frequent laboratory monitoring, is essential to reduce morbidity and mortality in the comprehensive treatment of these patients.
肿瘤溶解综合征是一种医疗急症。其表现可以是自发的，也可以是既定治疗的继发性结果。肿瘤溶解综合征（TLS）的诊断和治疗已成为治疗及靶向治疗发展与改进的关键目标。
2014年1月至2019年12月，我们对巴西一家三级医院18岁以上血液系统肿瘤住院患者进行了回顾性研究。我们在97例患者中识别出112次TLS发作。发病率为10.5%，中位总生存期为13.0个月（95%CI 6.2 - 19.7）。中位年龄为56岁（IQR 39.5 - 64）。最常见的诊断为多发性骨髓瘤（18.6%）、急性髓系白血病（17.5%）和弥漫性大B细胞淋巴瘤（17.5%）。所有患者均接受静脉补液。治疗还包括76%的病例使用别嘌醇，8例患者使用重组尿酸氧化酶。37%的病例需要进行肾脏替代治疗。在多变量分析中，年龄、HIV状态和重症监护病房治疗与总生存期显著相关。
TLS是血液系统恶性肿瘤中的一种严重并发症。使用风险分层评分，以及采取预防措施并通过频繁的实验室监测进行及时治疗，对于降低这些患者综合治疗中的发病率和死亡率至关重要。
