What is Tumor Lysis Syndrome & Can it be Prevented?
- Tumor lysis syndrome can occur when a patient’s body is not able to clear away waste released by dead cancer cells quickly enough after treatment for chronic lymphocyctic leukemia (CLL).
- Certain patients may be at an increased risk of developing this potentially serious side effect.
- Before treatment with certain CLL drugs, doctors will assess their patients risk of developing the syndrome.
- High-risk patients may begin their treatment process in the hospital so they can stay properly hydrated, and reduce their risk of developing the syndrome.
This side effect can often be prevented with proper hydration, but for some patients, this may involve getting fluids injected into their blood steam. Some patients who have a high risk of developing tumor lysis syndrome may need to be hospitalized during certain points in their treatment process so that they can be adequately hydrated and monitored for symptoms.
Read More- Chemoimmunotherapy
- Venetoclax
- Lenalidomide
- Obinutuzumab
“That’s where the cells, because our treatments are so effective, die all at the same time and can cause problems with a kind of sluggish blood if you will which can clog up the kidneys and cause kidney problems or cause electrolytes to be out of whack.”
Dr. Julie Vose explains why patients may be at risk for tumor lysis syndrome.
Dr. Vose noted that patients, particularly those taking obinutuzimab or the BCL-2 inhibitor venetoclax have to be closely monitored during the treatment process.
“They do have to sometimes be hospitalized for their first treatment, even as the doses are increased,” Dr. Vose explained. “Sometimes, we have to re-hospitalize the patients for those, mostly because they’re just so effective.”
How is Risk Assessed?
There are a few pre-cautions that doctors take when administering CLL treatments to avoid tumor lysis syndrome. One, for patients taking venetoclax, involves increasing dosage of the medication gradually to not overwhelm the patient’s body.
“The FDA-approved label for venetoclax includes starting at a very low dose and gradually ramping it up over the course of about five weeks to get up to the maximum dose,” Dr. Matthew Davids, associate director of the center for CLL at Dana-Farber Cancer Institute, told SurvivorNet.
Patients will need to be assessed for their risk of developing tumor lysis syndrome. This will include assessing:
- The size of their lymph nodes
- The degree of elevation of lymphocyte count in the blood
“Patients who are at high risk for tumor lysis syndrome do need to be hospitalized for their initial dosing of venetoclax,” Dr. Davids explained. “However, the responses to this drug can be excellent and so for most patients it’s worth investing some time getting started on the drug, to do so safely, and to achieve a good response.”
The targeted therapy venetoclax (brand name: Venclexta) works by attacking a specific protein called BCL-2 in cancer cells that helps them stay alive. The drug may be used to treat CLL patients who have a genetic change known as a 17p deletion or have already tried at least one other treatment. Venetoclax is also approved as a first treatment when used in combination with obinutuzumab (Gazyva), which is a class of drug known as a monoclonal antibody.
Treating Tumor Lysis Syndrome
If a patient does develop tumor lysis syndrome, treatment is similar to preventative measures, and may include intravenous (IV) fluids, uric acid reducers allopurinol and rasburicase, and blood work to monitor electrolyte levels and kidney damage, as well as testing to monitor hearth rhythm and urine output.
Dr. James Gerson, a hematologist and an assistant professor of clinical medicine at Penn Medicine, told SurvivorNet that the monitoring at the beginning of treatment for patients getting venetoclax and obinutuzumab can be a hassle, but that’ll subside over the treatment process.
Dr. James Gerson breaks down how the monitoring process works after treatment with venetoclax.
“Unfortunately, because of the risk to the kidneys, we have to keep a very close eye on the kidney function using blood work,” Dr. Gerson explained, adding that you may need to get blood work the day before, the day of, and the day after your cancer treatment.
This monitoring also helps doctors to figure out the right dose for each individual patient.
Questions to Ask Your Doctor:
- Am I at risk for developing tumor lysis syndrome?
- What symptoms should I be on the lookout for while undergoing treatment?
- What should I do if I experience symptoms of tumor lysis syndrome?
- Are there any precautions I can take before beginning treatment?
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