2024 Volume 31 Issue 3 Pages 209-212
A 70-year-old man was diagnosed with chronic lymphocytic leukemia at the age of 69 and was under observation. Ibrutinib was initiated due to stage progression. However, ibrutinib administration was discontinued after 1 month due to liver dysfunction. The peripheral hematological picture suggested diffuse large B-cell lymphoma. Four days after ibrutinib discontinuation, lactic acidosis with hypoglycemia was observed, and the patient was admitted to the ICU. Ventilatory management, blood glucose correction, fursultiamine administration, and blood purification therapy did not improve the patient's condition, and the Warburg effect on type B lactic acidosis was thought to be the cause. It was decided that intervention for the primary disease was necessary, and miniCHOP therapy (cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone) was started on the same day. On the next day, the lactate level improved and the number of tumor cells in the peripheral blood decreased. Although initiation of chemotherapy is often hesitated for patients with malignant tumors associated with lactic acidosis because of their poor general conditions, the possibility that earlier initiation may be effective should be considered.
