Case of Tumor-Lysis Syndrome After Combination CLL Therapy
Posted: Monday, August 31, 2020
A case study published in JCO Oncology Practice reported a duvelisib treatment-emergent case of tumor-lysis syndrome in a patient with relapsed or refractory chronic lymphocytic leukemia (CLL) who had previously undergone chimeric antigen receptor (CAR) T-cell therapy. Although tumor-lysis syndrome has been associated with B-cell lymphoma 2 inhibitor treatment, this may be the first documented case of the syndrome associated with the PI3K δ-γ inhibitor.
“This experience demonstrates the dangers and potential clinical benefits of combination immune therapies, such as PI3K plus CAR T cells, an area that is under active investigation,” concluded Parameswaran Hari, MD, of the Medical College of Wisconsin, and colleagues. “It also signifies the importance of monitoring for tumor-lysis syndrome in potential combinatorial studies with PI3Ks and CAR T cells.”
The study included a male patient, aged 55, who had previously received fludarabine and cyclophosphamide, rituximab, ibrutinib, venetoclax, and idelalisib. He then reached a partial response while receiving CAR T-cell therapy, before it was discontinued due to clinical evidence of progressive adenopathy. A few days after treatment discontinuation, the patient presented to an urgent care clinic due to pain from massive axillary adenopathy. That same day, he began receiving duvelisib monotherapy.
Within hours of treatment initiation, the patient demonstrated clinical indicators of tumor-lysis syndrome, such as new lymphocytosis and several electrolyte abnormalities. He was transferred to an emergency center, where he received fluids, insulin, calcium gluconate, kayexalate, phosphate binders, and rasburicase before being admitted to intensive care. Duvelisib treatment was suspended for more than 24 hours until his lab work indicated improvement. At that point, the patient received a second dose of 25 mg of duvelisib and again experienced lymphocytosis, with an elevated white blood cell count. However, the second dose resulted in only mild electrolyte abnormalities requiring no intervention. The patient continued to receive duvelisib treatment for a total of 4 months and achieved a partial response to therapy.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.