Systemic Inflammatory Response Syndrome and Multiple Organ Dysfunction in Patients with Acute Tumor Lysis Syndrome

Acute tumor lysis syndrome (ATLS) is observed in a well-defined group of patients with rapidly proliferating malignancies and results in the destruction and lysis of malignant cells. Lysis of cells results in the subsequent release of intracellular ions and metabolites into the bloodstream, thus leading to hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. This syndrome occurs either as a consequence of diverse anticancer treatments or, less frequently, spontaneously. Although most patients with ATLS are asymptomatic, acute renal failure (ARF), metabolic acidosis, life-threatening electrolyte abnormalities, cardiac arrhythmias, or seizures may accompany the syndrome, thereby increasing the risk of associated death. 2 Systemic inflammatory response syndrome (SIRS) is a pathologic reaction triggered by a variety of insults, including infection, trauma, burns, and acute pancreatitis. SIRS becomes more severe when it is complicated by organ dysfunction. SIRS-like syndromes have been reported in patients with hematologic tumors, which reflects rapid cytoreduction. SIRS and multiple organ dysfunctions (MOD) associated with ATLS would seem to be physiologically plausible; however, no study has addressed this issue to the best of our knowledge. In this manuscript, we report five patients who developed ATLS associated with SIRS and MOD in the absence of clear alternative explanations. PATIENTS AND METHODS