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      Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies: a systematic review.

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          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.

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          Author and article information

          Journal
          Ann. Hematol.
          Annals of hematology
          Springer Nature
          1432-0584
          0939-5555
          Mar 2016
          : 95
          : 4
          Affiliations
          [1 ] University of Memphis, School of Health Studies, Memphis, TN, 38002, USA. Scott.howard@worldchildcancer.us.
          [2 ] Northwestern Memorial Hospital, Chicago, IL, USA.
          [3 ] Colorado Blood Cancer Institute at Presbyterian St. Luke's Medical Center, Denver, CO, USA.
          [4 ] University of Arkansas for Medical Sciences, Myeloma Institute, Little Rock, AR, USA.
          [5 ] The University of Arizona Cancer Center, Tucson, AZ, USA.
          Article
          10.1007/s00277-015-2585-7
          10.1007/s00277-015-2585-7
          26758269
          f27c566f-3b36-41ba-89a8-8bedc0140d34
          History

          Targeted treatment,Hematologic malignancies,Tumor lysis syndrome,Prophylaxis

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