Clinical Case Kasuistik

Acute Tumor Lysis Syndrome during Oral Fludarabine Treatment for Chronic
Lymphocytic Leukemia. Role of Treatment with Rasburicase
Jose Manuel Calvo-Villasa, Basilio Martn Urcuyob, Adelaida Morales Umpierrezb, Francisco
Siciliaa
a

Department of Hematology,
Department of Nephrology, Hospital General de Lanzarote, Arrecife de Lanzarote, Spain

Onkologie 2008;31:197-199 (DOI: 10.1159/000118524)

Summary
Introduction: Oral fludarabine is the first oral formulation of a purine analogue available for
clinical use which has produced encouraging results in patients with B-cell chronic lymphocytic
leukemia (CLL). It has a similar tolerability profile to that of the intravenous formulation. Acute
tumor lysis syndrome (TLS) induced by fludarabine appears to be a fairly unusual complication
during the treatment of CLL. Case Report: The present report describes the case of a 78-year-old
man who developed acute renal failure associated with TLS following the first course of oral
fludarabine. Laboratory investigations fulfilled the TLS typical criteria, including hyperkalemia,
marked hyperuricemia, hyperphosphatemia, hypocalcemia, and acute renal failure. Despite the
many documented side effects of oral fludarabine, there is only one similar case of oral
fludarabine-induced TLS reported to date. Conventional therapy with short-term supportive
hemodialysis and a short treatment of rasburicase for 2 days achieved a complete recovery of
renal function and a decrease of the urate level to within the normal range. Conclusions:
Clinicians should be alert to this potentially life-threatening metabolic emergency among CLL
patients treated with oral fludarabine.
Copyright 2008 S. Karger AG, Basel

Author Contacts
Jose M. Calvo-Villas, MD Hematology Department, Hospital General de Lanzarote Carretera de
Arrecife-Tinajo km 1,300 35500 Arrecife de Lanzarote, Las Palmas, Spain Tel. +34 928595-305,
Fax -066. E-mail jmcvillas@hotmail.com