Rare Case of Lactic Acidosis Associated with Small Lymphocytic Lymphoma (SLL) in Elderly Man Published in Journal of Cancer Research and Oncobiology

A team of researchers from Hackensack Meridian Jersey Shore University Medical Center and the Cleveland Clinic, led by Professor of Medicine and Nephrologist Sushil K. Mehandru, M.D., authored a new report, “A Rare Case of Lactic Acidosis Associated with Small Lymphocytic Lymphoma,” published recently in the Journal of Cancer Research and Oncobiology.1 It is believed to be the first-ever report of lactic acidosis in a patient with small lymphocytic lymphoma (SLL), a slow-growing cancer of the lymphatic system, the body’s disease fighting network.

“Several types of lymphomas have been associated with type B lactic acidosis, although small lymphocytic lymphoma (SLL) has not been, to the best of our knowledge,” said Dr. Mehandru. “We reported on one known case in an 87-year-old man with SLL who was admitted to the hospital for chemotherapy. Lactic acidosis was present when he was admitted, and it progressed within 48 hours to lactic acid levels of over 10 mmol/L, a substantial increase from the 2.8 mmol/L level recorded on his admission. Given the rarity and seriousness of this complication, we believed it merited closer examination.”

In some cases of B-cell lymphoma, thiamine deficiency has been reported to cause Type B lactic acidosis. This type of lactic acidosis may be corrected with thiamine administration.

Dr. Mehandru explained that the presence of lactic acidosis in a patient with SLL is a poor prognostic factor, and that chemotherapy is indicated in patients with SSL and concomitant lactic acidosis. Chemotherapy and thiamine together have been studied as treatments, although overall prognosis remains poor. The patient in the published case report received thiamine to treat the lactic acidosis during his hospital admission, however the lactic acidosis continued to worsen. 

The authors recommend early administration of chemotherapy and thiamine to treat lactic acidosis in the setting of SSL, if thiamine levels are low. This intervention may slow the rise of lactic acid in patients with lymphoma and leukemias, particularly small lymphocytic lymphoma.

“We know that Type B lactic acidosis in patients with malignancy has an extremely poor prognosis,” said Dr. Mehandru. “Several kinds of lymphomas and leukemias have been reported with severe type B lactic acidosis, and the outcomes are poor across the spectrum, regardless of chemotherapy, ICU management or treatment with thiamine. Because Type B lactic acidosis is a rare complication in the setting of small lymphocytic lymphoma, and this rare occurrence is not completely understood, we recommend more studies be done in this area of cancer research and oncobiology.”

Lactic acidosis is a metabolic process that begins when a person overproduces or underutilizes lactic acid, and their body is not able to adjust to these changes. Lactic acid is a chemical byproduct of the process by which cells produce energy without oxygen, such as in overexertion from exercise. Lactic acid build-up occurs when there is not enough oxygen in the muscles to break down glucose and glycogen, chemical byproducts of the process by which cells produce energy. People with lactic acidosis have problems with their liver, and sometimes kidneys, being able to remove excess acid from their bodies. It is a medical emergency, and in a majority of cases it reflects tissue depleted of oxygen supply.

Type B lactic acidosis is a rare occurrence in patients with lymphomas, leukemias, and solid neoplasms, or abnormal growths of tissue. It is caused by impairment of cellular functioning and localized areas of reduced blood flow in tissues. Type B lactic acidosis is believed to be a result of drug or toxin interference of cellular metabolism or a nutritional deficiency state. The mechanism behind Type B lactic acidosis is not completely understood and may be multifactorial. It may be partly explained by an enhanced activity in the cancer cell triggered by oncogenic lesions. These changes may ultimately promote increased glucose uptake by the tumor and diversion from the normal oxidative process towards a glycolytic pathway with generation of lactate.2

References

  1. Mehandru S, Kaur S, Dattadeen J, Erler B, Asif, A, et al. A Rare Case of Lactic Acidosis Associated with Small Lymphocytic Lymphoma. J Cancer Res. Oncobiolog. 2020 Dec; 3(3): 131.
  2. Type B lactic acidosis: a rare but life-threatening hematologic emergency. A case illustration and brief review. Wenderson M Claudino, Ajoy Diase and Vivek R. Sharma, Am J Blood Res. 2015; 5(1) 25-29. Published online.