Successful treatment of a patient with tumor lysis syndrome using high-efficiency daily diafiltration technique to avoid further tumor lysis during chemotherapy

Abstract

We recently experienced a patient with tumor lysis syndrome (TLS) secondary to Burkitt’s lymphoma who was successfully treated with a combination of chemotherapy and sustained high-efficiency daily diafiltration using a mediator adsorbing membrane (SHEDD-fA) without any deterioration in his clinical condition. [Case] A man in his 60s was admitted to the intensive care unit (ICU) due to the exacerbation of Burkitt’s lymphoma complicated with pneumonia and disseminated intravascular coagulation. He was diagnosed with spontaneous TLS presenting with extreme acidosis, hyperkalemia, hyperuricemia, anuria, and life-threatening electrolyte abnormalities and renal failure. SHEDD-fA was performed immediately, and his general condition gradually improved. On days 2 and 3 after the patient’s ICU admission, prednisolone (1mg/kg/day) was administered. After confirming that the patient’s condition had not significantly deteriorated, combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) was started on day 4. No TLS-induced adverse events occurred during the course of the chemotherapy. Although it is avoidable to give chemotherapy in patients with high-grade lymphomas occurring spontaneous TLS, we conclude that SHEDD-fA potentially enables chemotherapy more safe.