From the Guidelines
Acute leukemia can cause acidosis, particularly as a result of tumor lysis syndrome, which is characterized by the release of intracellular metabolites into the blood after the rapid lysis of malignant cells. This condition is observed most frequently in patients with hematologic malignancies such as acute lymphoblastic leukemia (ALL) and Burkitt’s lymphoma after the initiation of cytotoxic therapy, although it may also occur spontaneously and/or in other tumor types with a high proliferative rate, large tumor burden, or high sensitivity to cytotoxic therapy 1. The release of intracellular metabolites, including nucleic acids, proteins, phosphorus, and potassium, can overwhelm normal homeostatic mechanisms, potentially leading to hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and uremia, all of which can contribute to the development of acidosis.
Some key points to consider in the management of acidosis in acute leukemia include:
- Awareness of the causes and physiologic consequences of tumor lysis syndrome
- Identification of high-risk patients and implementation of appropriate prophylactic measures
- Vigilant monitoring of electrolyte levels in patients undergoing chemotherapy
- Initiation of more active treatment measures when necessary, such as intravenous fluids, electrolyte correction, and sometimes sodium bicarbonate for severe acidosis
- Prompt recognition and treatment of acidosis, as it can significantly impact patient outcomes in acute leukemia, affecting morbidity, mortality, and quality of life 1.
The management of acidosis in acute leukemia should focus on treating the underlying leukemia with appropriate chemotherapy regimens while providing supportive care to mitigate the effects of tumor lysis syndrome and other mechanisms contributing to acidosis. The goal is to prevent or minimize the development of acidosis and its complications, thereby improving patient outcomes and quality of life.
From the Research
Acute Leukemia and Acidosis
- Acute leukemia can lead to acidosis, particularly in the context of tumor lysis syndrome (TLS) 2, 3, 4.
- TLS is a life-threatening condition characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and/or azotemia, secondary to rapid breakdown of tumor cells 2.
- Acidosis can also occur in the form of lactic acidosis, which is a rare condition in patients with hematological malignancies, including acute leukemia 5.
- The development of acidosis in acute leukemia is often related to increased tumor burden and rapid cell lysis, which can be exacerbated by chemotherapy 5, 6.
- Risk factors for TLS and acidosis in acute leukemia include high white blood cell count, hepatomegaly, splenomegaly, lymphadenopathy, elevated liver enzymes, and renal insufficiency 4.
- Management of TLS and acidosis in acute leukemia involves aggressive hydration, urine alkalinization, forced diuresis, and high-dose allopurinol, as well as careful monitoring of fluid balance and electrolyte levels 2, 3, 6.