Tumor lysis syndrome in patients with light chain multiple myeloma: report of two cases

Tumor lysis syndrome (TLS) is a severe life-threatening complication which typically occurs in highly proliferative malignancies, such as Burkitt's lymphoma, acute leukemia or germ cell tumors. Although TLS is unusual in multiple myeloma, it should not be overlooked as it is associated with significant morbidity. In recent years, emerging new agents such as thalidomide and bortezomib have been found to be highly effective in the treatment of multiple myeloma. In this milieu, there is greater concern that the rate of TLS in multiple myeloma will increase. We herein report 2 patients with light chain multiple myeloma who developed TLS during treatment. One patient improved after hydration, allopurinol and forced diuresis. The other underwent hemodialysis because of oliguria. These 2 patients did not have heavy tumor burdens. They also lacked risk factors of TLS that were described in previous reports. Our experience suggests light chain myeloma with underlying myeloma kidney is associated with a risk of TLS. Clinical awareness, close monitoring and early intervention are the keystones in the management of these patients.