Korean J Hematol.  2006 Jun;41(2):119-123. 10.5045/kjh.2006.41.2.119.

Tumor Lysis Syndrome in Lymphoblastic Crisis of CML

• Lee DJ
• Choi CU
• Lee CS
• Lee HH
• Park JK
• Choi JH
• Lee YY
• Kim IS

• KMID: 2083487
• DOI: http://doi.org/10.5045/kjh.2006.41.2.119

Abstract

Tumor lysis syndrome (TLS) defines the metabolic derangements that occur with tumor breakdown following the initiation of cytotoxic therapy. TLS results from the rapid destruction of malignant cells and the abrupt release of intracellular materials and their metabolites into the extracellular space. The syndrome causes hyperuricemia, hyperkalemia, hyperphosphatemia, secondary hypocalcemia and uremia. It can result in acute renal failure and be fatal. Early recognition of patient at risk and preventive measures are important. There is a high incidence of TLS in tumors with high proliferative rates and large burden such as acute lymphoblastic leukemia and Burkitt's lymphoma. It less commonly occurs in solid tumors such as testicular cancer, breast cancer and small cell lung cancer. There are only a few reports on TLS complicated in CML in blast crisis. So we report a 45-yr-old woman presenting with TLS associated with CML in lymphoblastic crisis after the initiation of cytotoxic chemotherapy.

Keyword

Tumor lysis syndrome; Chronic myelogeous leukemia; Blast crisis

MeSH Terms

Acute Kidney Injury
Blast Crisis
Breast Neoplasms
Burkitt Lymphoma
Drug Therapy
Extracellular Space
Female
Humans
Hyperkalemia
Hyperphosphatemia
Hyperuricemia
Hypocalcemia
Incidence
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Small Cell Lung Carcinoma
Testicular Neoplasms
Tumor Lysis Syndrome*
Uremia

Figure

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  Fig. 1 Peripheral blood smear. Marked leukocytosis composed of immature blasts (44%), band form (5%), promyelocyte (3%), myelocyte (10%), metamyelocyte (7%), segmented neutrophils (13%), eosinophils (3%), monocyte (2%) and lymphocytes (9%) is observed. Moderate decrease of platelet component is also observed. (A) ×40, (B) ×200.

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  Fig. 2 Bone marrow biopsy. (A) Bone marrow biopsy imprint (touch preparation), More than 30% of all hematopoietic cells are replaced by immature cells. These cells show high nuclear/ cytoplasmic ratio, one or more prominent nucleoli, and fine nuclear chromatin. These cells also vary in size from medium to large. The myeloid series are increased in proportion and reveal normal maturation. The erythroid series are decreased in proportion and reveal normal maturation. The megakaryocytes are decreased in number. (B) The bone marrow section is hypercellular (90%) for her age. Immature cells are seen throughout section intermingled with other hematopoietic cells.

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