Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies

a systematic review

Scott Howard, Steven Trifilio, Tara K. Gregory, Nadine Baxter, Ali McBride

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Effective new treatments are now available for patients with hematologic malignancies. However, their propensity to cause tumor lysis syndrome (TLS) has not been systematically examined. A literature search identified published Phase I–III clinical trials of monoclonal antibodies (otlertuzumab, brentuximab, obinutuzumab, ibritumomab, ofatumumab); tyrosine kinase inhibitors (alvocidib [flavopiridol], dinaciclib, ibrutinib, nilotinib, dasatinib, idelalisib, venetoclax [ABT-199]); proteasome inhibitors (oprozomib, carfilzomib); chimeric antigen receptor (CAR) T cells; and the proapoptotic agent lenalidomide. Abstracts from major congresses were also reviewed. Idelalisib and ofatumumab had no reported TLS. TLS incidence was ≤5 % with brentuximab vedotin (for anaplastic large-cell lymphoma), carfilzomib and lenalidomide (for multiple myeloma), dasatinib (for acute lymphoblastic leukemia), and oprozomib (for various hematologic malignancies). TLS incidences were 8.3 and 8.9 % in two trials of venetoclax (for chronic lymphocytic leukemia [CLL]) and 10 % in trials of CAR T cells (for B-cell malignancies) and obinutuzumab (for non-Hodgkin lymphoma). TLS rates of 15 % with dinaciclib and 42 and 53 % with alvocidib (with sequential cytarabine and mitoxantrone) were seen in trials of acute leukemias. TLS mitigation was employed routinely in clinical trials of alvocidib and lenalidomide. However, TLS mitigation strategies were not mentioned or stated only in general terms for many studies of other agents. The risk of TLS persists in the current era of novel and targeted therapy for hematologic malignancies and was seen to some extent with most agents. Our findings underscore the importance of continued awareness, risk assessment, and prevention to reduce this serious potential complication of effective anticancer therapy.

Original languageEnglish (US)
Pages (from-to)563-573
Number of pages11
JournalAnnals of Hematology
Volume95
Issue number4
DOIs
StatePublished - Mar 1 2016

Fingerprint

Tumor Lysis Syndrome
alvocidib
Proxy
Hematologic Neoplasms
T-Cell Antigen Receptor
Clinical Trials
Anaplastic Large-Cell Lymphoma
Mitoxantrone
Proteasome Inhibitors
Cytarabine
Incidence
B-Cell Lymphoma
B-Cell Chronic Lymphocytic Leukemia
Multiple Myeloma
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Protein-Tyrosine Kinases
Non-Hodgkin's Lymphoma
Leukemia
Therapeutics
Monoclonal Antibodies

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies : a systematic review. / Howard, Scott; Trifilio, Steven; Gregory, Tara K.; Baxter, Nadine; McBride, Ali.

In: Annals of Hematology, Vol. 95, No. 4, 01.03.2016, p. 563-573.

Research output: Contribution to journalArticle

Howard, Scott ; Trifilio, Steven ; Gregory, Tara K. ; Baxter, Nadine ; McBride, Ali. / Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies : a systematic review. In: Annals of Hematology. 2016 ; Vol. 95, No. 4. pp. 563-573.
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