Malignancy-induced lactic acidosis in adult lymphoma

Clin Nephrol. 2021 Jan;95(1):1-21. doi: 10.5414/CN110116.


Malignancy-induced lactic acidosis (MILA), a rare paraneoplastic phenomenon, is mostly described with hematologic malignancies (lymphomas and leukemias) but has also been reported with solid tumors. It is a subset of type B lactic acidosis being mediated without evidence of tissue hypoperfusion. Lymphoma-induced lactic acidosis is often considered an oncologic emergency and is associated with an increased risk of mortality and poor prognosis. It has a complex pathophysiology centered in the "Warburg effect," i.e., the programming of cancer cells to depend on aerobic glycolysis for promotion of their proliferation and anabolic growth. The treatment of lymphoma-induced lactic acidosis is focused on prompt administration of chemotherapy. The role of alkali therapy in this setting is controversial and has limited proven benefit with a potential for worsening the lactic acidosis. If alkali therapy is used in the presence of severe acidemia to optimize cardiovascular status, it should be administered judiciously.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acidosis, Lactic / drug therapy
  • Acidosis, Lactic / etiology*
  • Aged
  • Alkalies / therapeutic use
  • Humans
  • Lymphoma / complications*
  • Male
  • Middle Aged


  • Alkalies