Lactic Acidosis in Hematologic Malignancies
Summary
Lactic acidosis is a metabolic complication characterised by accumulation of lactate in the bloodstream with resultant acid–base disturbance. In patients with haematologic malignancies, a subtype known as type B lactic acidosis arises in the absence of overt tissue hypoxia and is driven by aberrant cancer cell metabolism. Rapidly proliferating leukaemias and lymphomas often exhibit upregulated glycolysis and impaired mitochondrial function, leading to excessive lactate production (lactagenesis) even under well-oxygenated conditions. Tumour burden, hepatic infiltration and concomitant metabolic derangements further compromise lactate clearance. Clinically, presentation ranges from mild fatigue and anorexia to severe hypotension, hypoglycaemia and multi-organ failure. Type B lactic acidosis carries a poor prognosis and frequently heralds advanced disease. Prompt recognition is critical: urgent cytoreductive therapy can reverse metabolic acidosis, whereas supportive measures alone have limited impact. Understanding the interplay between tumour biology, host metabolism and organ function has spawned new approaches to risk stratification, early intervention and targeted modulation of cancer metabolism.
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Lactic Acidosis in Hematologic Malignancies publication trend
The graph below shows the total number of articles in lactic acidosis in hematologic malignancies across all publications each year (not limited to Nature Index journals).
Technical terms
Lactic acidosis: A state of raised blood lactate concentration leading to decreased pH.
Type B lactic acidosis: Lactic acidosis that occurs in the absence of tissue hypoxia, often driven by metabolic reprogramming in malignancy.
Warburg effect: The propensity of cancer cells to favour glycolysis and lactate production despite adequate oxygen availability.
Aerobic glycolysis: Metabolic pathway in which glucose is converted to lactate under oxygenated conditions.
Haematologic malignancy: Cancer originating in blood-forming tissues, including leukaemias and lymphomas.
References
- Clinical Warburg effect in lymphoma patients admitted to intensive care unit. Annals of Intensive Care (2023).
- An Oncological Emergency: Severe Type B Lactic Acidosis From Warburg Effect in Diffuse Large B-cell Lymphoma. Cureus (2022).
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