A case of diffuse large B-cell lymphoma followed by severe lactic acidosis treated with early chemotherapy in ICU

DOI Web Site 14 References
  • Hibi Daisuke
    Department of Intensive Care Medicine, Toyama University Hospital
  • Tanaka Takeo
    Department of Intensive Care Medicine, Kanazawa University Hospital
  • Mouri Hideyuki
    Department of Intensive Care Medicine, Kanazawa University Hospital
  • Yokawa Junichiro
    Department of Intensive Care Medicine, Kanazawa University Hospital
  • Sato Koji
    Department of Intensive Care Medicine, Kanazawa University Hospital
  • Taniguchi Takumi
    Department of Intensive Care Medicine, Kanazawa University Hospital

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Other Title
  • 高度の乳酸アシドーシスを呈したためにICUで早期に化学療法を導入したびまん性大細胞型B細胞性リンパ腫の1例

Abstract

<p>A 70-year-old man was diagnosed with chronic lymphocytic leukemia at the age of 69 and was under observation. Ibrutinib was initiated due to stage progression. However, ibrutinib administration was discontinued after 1 month due to liver dysfunction. The peripheral hematological picture suggested diffuse large B-cell lymphoma. Four days after ibrutinib discontinuation, lactic acidosis with hypoglycemia was observed, and the patient was admitted to the ICU. Ventilatory management, blood glucose correction, fursultiamine administration, and blood purification therapy did not improve the patient's condition, and the Warburg effect on type B lactic acidosis was thought to be the cause. It was decided that intervention for the primary disease was necessary, and miniCHOP therapy (cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone) was started on the same day. On the next day, the lactate level improved and the number of tumor cells in the peripheral blood decreased. Although initiation of chemotherapy is often hesitated for patients with malignant tumors associated with lactic acidosis because of their poor general conditions, the possibility that earlier initiation may be effective should be considered.</p>

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