Futility of dialysis in patients with tumor lysis syndrome in advanced hematological malignancy: A case series

Introduction: Type-B lactic acidosis and tumor lysis syndrome (TLS) can occur in patients with advanced hematological malignancies. In these patients, TLS can lead to an acute kidney injury (AKI) as hyperuricemia and hyperphosphatemia cause crystal nephropathy. Patients with this presentation are frequently started on dialysis. However, it is rare for patients to present with the constellation of hematological malignancy, type-B lactic acidosis, TLS, and AKI, and there is a lack of data on dialysis outcomes in these complex patients. Methods: We performed a single-center retrospective study at the Medical University of South Carolina, using the TriNetX search to identify adult patients presenting with hematological malignancy, type-B lactic acidosis, TLS, and AKI. After applying exclusion criteria, we identified 10 patients. Results: Nine patients had a stage 3 AKI and one patient had a stage 2 AKI. Dialysis was initiated in 70% of patients. The median time from TLS diagnosis to initiation of dialysis was 1 day and the median duration of dialysis was 2 days. Death occurred in 100% of patients within 12 months. The median time from onset of TLS to death was 4.5 days. There was no statistically significant difference in time to death between the dialysis and no dialysis groups ( p = 0.373). Discussion: The mortality rate and short time to death despite treatment optimization suggest that in patients with an underlying hematological malignancy, presentation with the constellation of type-B lactic acidosis, TLS, and AKI is an indicator of poor prognosis. Larger, well-designed studies are needed to determine the utility of dialysis in these patients.