Premium
Lactic acidosis: A metabolic complication of hematologic malignancies
Author(s) -
Sillos Elaine M.,
Shenep Jerry L.,
Burghen George A.,
Pui ChingHon,
Behm Frederick G.,
Sandlund John T.
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20011101)92:9<2237::aid-cncr1569>3.0.co;2-9
Subject(s) - lactic acidosis , medicine , hypoglycemia , lymphoma , acidosis , pathogenesis , leukemia , cancer , gastroenterology , chemotherapy , acute leukemia , pathophysiology , complication , sepsis , endocrinology , immunology , insulin
BACKGROUND Lactic acidosis (LA) associated with hematologic malignancies is rare, ominous, and generally occurs in adults. Its pathogenesis is poorly understood. METHODS The authors present one case of childhood lymphoma and two cases of childhood leukemia associated with LA, and they review the available literature. Plasma concentrations of insulin‐like growth factors (IGFs), IGF binding proteins (IGFBPs), and tumor necrosis factor (TNF)‐α were retrospectively measured to elucidate the pathogenesis of LA. RESULTS Lactic acidosis has been reported to date in 28 cases of lymphoma and 25 cases of leukemia, including the authors' cases. Ongoing rapid cellular proliferation was indicated in all leukemia cases. The liver was involved in 43 of the 53 cases, and hypoglycemia was present in 20. The acidosis improved only if the disease responded to chemotherapy. Remission was achieved in only five of the reported cases. In the authors' three cases, LA was associated with altered concentrations of IGFs, IGFBPs, and TNF‐α, although causality was not established. CONCLUSIONS Lactic acidosis in association with hematologic malignancies carries an extremely poor prognosis. Because cancer cells have a high rate of glycolysis and produce a large quantity of lactate, this condition may result from an imbalance between lactate production and hepatic lactate utilization. The authors speculate that the IGF system is involved in the pathophysiology of LA in these patients. Only chemotherapy so far has been effective in correcting the acute acidosis in a few patients; however, it has not necessarily improved ultimate outcome. Cancer 2001;92:2237–46. © 2001 American Cancer Society.