POSTER'11'
SPONTANEOUS'TUMOR'LYSIS'SYNDROME:'A'RARE'PRESENTATION'IN'
PLASMABLASTIC'LYMPHOMA'
'
Joana!Brioso!Infante1,2,!Andre!Casado2,!Antonio!Almeida3!and!Antonio!Messias2!
!
(1)Department! of! Hematology! and! Bone! Marrow! Transplantation! U! Centro! Hospitalar! Lisboa! Norte,!
Hospital! de! Santa! Maria,! Lisboa,! Portugal,! (2)Intensive! Care! Unit,! Hospital! da! Luz! Lisboa,! Lisbon,!
Portugal,!(3)Department!of!Hematology,!Hospital!da!Luz!Lisboa,!Lisbon,!Portugal!
!
Introduction:!
Lymphoproliferative! disorders! can! rarely! present! with! severe! spontaneous! tumor! lysis!
syndrome! (sTLS),! an! oncological! emergency! which! can! ultimately! lead! to! death! if! not!
recognized!early!and!treated!accordingly.!This!rare!presentation!is!more!common!in!Burkitt’s!
leukemia! and! acute! lymphoblastic! leukemia;! reports! of! sTLS! occurring! in! Plasmablastic!
Lymphoma!(PbL)!are!extremely!scarce,!and!its!outcome!seems!to!be!very!poor.!
We!present!a!case!of!a!patient!presenting!with!lifeJthreatening!sTLS,!later!found!to!occur!in!
the!context!of!a!subjacent!PbL,!which!was!managed!successfully!in!our!Intensive!Care!Unit.!
Case'report:!
A!58Jyear!old!male!presented!with!a!1Jmonth!history!of!anorexia,!hematuria!and!abdominal!
distension.!He!had!been!diagnosed!with!HIVJ1!infection!8!months!previously!and!was!under!
triple!antiviral!therapy.!
Bloodwork! was! remarkable! only! for! slight! elevation! of! creatinine! (1,65! mg/dL).! An!
abdominopelvic!CT!scan!showed!a!large!mass!(7x8!cm)!emerging!from!the!bladder!wall!and!
projecting!into!the!bladder!cavity,!and!the!lesion!was!biopsied!through!cystoscopy.!
In! the! following! week,! the! patient! complained! of! progressive! abdominal! distension,! and!
oliguria.!Blood!work!now!revealed!critical!decline!in!renal!function,!with!a!creatinine!of!14,03!
mg/dL,! plus! there! were! multiple! metabolic! disturbances,! namely! hyperkalemia! (K+!6,6!
mmol/L),! hyperphosphatemia! (serum! phosphate! 7,7! mg/dL),! hyperuricemia! (uric! acid! 24,9!
mg/dL),! hypocalcemia! (8,5! mg/dL),! metabolic! acidemia! and! high! LDH! (2012! UI/L).!
Electrocardiogram! showed! no! acute! abnormalities! and! the! chest! xJray! revealed! a! bilateral!
pleural!effusion.!Urgent!CT!scan!revealed!a!marked!growth!of!the!bladder!wall!mass!(10!by!
10! cm),! now! most! of! it! occupying! the! retroperitoneum,! and! supradiaphragmatic!
adenopathies.!
The!patient!was!urgently!admitted!to!the!ICU!and!was!treated!with!0,15!mg/kg!rasburicase,!
and!underwent!urgent!hemodialysis!for!oliguria!and!refractory!hyperkalemia.!
Preliminary! histopathology! reports! from! the! bladder! biopsies! showed! large! immunoblastic!
cells! expressing! CD138,! CD38,! MUM1! and! EBER,! with! a! very! high! proliferative! rate,!
consistent! with! a! Plasmablastic! Lymphoma.! 5Jday! highJdose! methylprednisolone! and!
emergent! debulking! chemotherapy! with! 500! mg! cyclophosphamide! iv! were! begun! after!
hemodialysis.!
The! patient! required! 3! further! hemodialysis! sessions,! due! to! severe! hyperphosphatemia!
aggravated!after!chemotherapy.!Diuresis!recovered,!and!the!patient’s!creatinine!normalized,!
thus!permitting!completion!of!firstJline!chemotherapy!protocol.!
Discussion:'!
This! report! highlights! the! importance! of! early! recognition! and! treatment! of! sTLS,! even! in!
patients! with! tumors! not! usually! presenting! with! this! complication! such! as! PbL,! and! the!
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES