Dear Editor
We read the article titled “Treatment of tumor lysis syndrome with the highest known uric acid level.”Citation1 When we first read we had a suspicion about it; because the highest uric acid level of 71.3 mg/dL was considerably greater than the levels reported in literature. However, we have experienced a similar case with a uric acid level of 60.4 mg/dL and our idea has changed. Therefore, we share this tumor lysis syndrome tumorlysis syndrome (TLS) case and discuss it here.
A 46-year-old male patient with TLS was admitted to our outpatient clinic with complaints of fatigue and general health discomfort. He had chronic myeloid leukemia (CML, Philadelphia positive) and he was taking imatinib 400 mg/day. In the laboratory findings, creatinine was 16.4 mg/dL, uric acid 60.4 mg/dL, potassium 6.5 mmol/L, Ca 8.3 mg/dL, lactic dehydrogenase 769 U/L, WBC 29.8 × 109/L, Hb 5.4 g/dL, and Plt 39 × 109/L. Peripheral blood smear showed that CML had been transformed to acute myeloid leukemia. The patient was treated successfully by sequential hemodialysis sessions (total eight sessions) and therapeutic agents such as allopurinol. According to our knowledge, uric acid level of this case is the second highest value reported in the literature. In our patient, transformation of CML to acute myeloid leukemia was observed after TLS had developed. This is similar to the reported patient's relapse to acute lymphoblastic leukemia after TLS.Citation1
In the case report of Ozkan et al.,Citation1 it was written that TLS rarely occurs after treatment; we think it is a typo. Because TLS is a phenomena usually associated with tumor cell death after treatment.Citation2,Citation3 In addition, in the previous paper it was reported that uric acid has many deleterious effects on the pathophysiology of TLS and one of them is the increment of the free oxygen radicals. However, in the literature contrary to this information it is reported that uric acid is a powerful water-soluble antioxidant and radical scavenger in humans whose generation is increased in situations of oxidative stress, such as brain ischemia.Citation4 Therefore, in the setting of acute renal failure even if uric acid has many deleterious effects, it may have some possible protective effect on renal or other organs through its antioxidant properties.
Abdulkadir Basturk
Department of Hematology, Ankara Ataturk Training & Research Hospital, Bilkent University,
Ankara, Turkey
E-mail: [email protected]
Tuba Hacibekiroglu
Department of Hematology, Ankara Ataturk Training & Research Hospital, Bilkent University,
Ankara,Turkey
E-mail: [email protected]
Sema Akinci
Department of Hematology, Ankara Ataturk Training & Research Hospital, Bilkent University,
Ankara,Turkey
E-mail: [email protected]
Imdat Dilek
Department of Hematology, Ankara Ataturk Training & Research Hospital, Bilkent University,
Ankara,Turkey
E-mail: [email protected]
Haci Veli Atalay
Department of Nephrology, Ankara Ataturk Training & Research Hospital, Bilkent University,
Ankara,Turkey
E-mail: [email protected]
REFERENCES
- Ozkan G, Ulusoy S, Sönmez M, Kaynar K, Karagülle M. Treatment of tumor lysis syndrome with the highest known uric acid level. Ren Failure. 2010;32(7):895–898.
- Opyrchal M, Figanbaum T, Ghosh A, Rajkumar V, Caples S. Spontaneous tumor lysis syndrome in the setting of B-cell lymphoma. Case Report Med. 2010;2010:610969. Epub 2010 March 10.
- Haas M, Ohler L, Watzke H, Böhmig G, Prokesch R, Druml W. The spectrum of acute renal failure in tumour lysis syndrome. Nephrol Dial Transplant. 1999;14(3):776–779.
- Chamorro A, Planas AM, Muner DS, Deulofeu R. Uric acid administration for neuroprotection in patients with acute brain ischemia. Med Hypotheses. 2004;62(2):173–176.