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Allopurinol and TLS

Posted by Frederick Wasti
Mar 30 2012

This morning I took my last Allopurinol pill. I was prescribed Allopurinol for the first ten days of the clinical trial. Allopurinol is often prescribed for people with gout, which generally involves a buildup of uric acid crystals in the joints. However, in my case, Allopurinol was prescribed as a preventative medication against Tumor Lysis Syndrome (TLS).

"Tumor lysis syndrome (TLS) refers to the constellation of metabolic disturbances that may be seen after initiation of cancer treatment. [...] A potentially lethal complication of anticancer treatment, tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly, leading to release of intracellular ions and metabolic byproducts into the systemic circulation. Clinically, the syndrome is characterized by rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute renal failure."

"Acute renal failure" - Ouch !!!

Basically, the number of blood cells killed during the onset of treatment may release a large amount of several toxic breakdown chemicals, especially uric acid, into the bloodstream, which presents quite a burden for the kidneys to handle.

Technically, Allopurinol is "a xanthine oxidase inhibitor, which inhibits uric acid production". (Right - <g>.) Basically, the Allopurinol minimizes any buildup of uric acid, in this case not for preventing gout, but for minimizing damage to the kidneys.

Another strategy for helping the kidneys during treatment is to force a lot of saline solution ("Ringer's solution") intravenously while the anti-leukemia chemicals are being infused. The result is that, although I do literally spend hours in an infusion chair when at Dana-Farber, I can vouch for the fact that I also spend part of that time trucking back and forth to and from the rest room, wheeling my infusion bags and infusion pumps behind me - <g>. (Quite an image, eh?)

(And, of course, I have been instructed to drink lots of fluids all day at home, a requirement that Diane helps to enforce.)

So, having taken my last Allopurinol pill means that I've passed a milestone of sorts, I guess, because, when it comes to Tumor Lysis Syndrome, it's not worth kidney-ing around. :-)

Categories: Leukemia