Clinical and la
Clinical and laboratory approach for the identification of the risk for tumour lysis syndrome in children with acute lymphoblastic leukemia.
Hesham A. Abdel-Baset1, Eman Nasr Eldin1, Azza A. Eltayeb2, Almontaser M. Hussein2.
1.Clinical Pathology Department, 2. Pediatric Department, Faculty of Medicine, Assiut University- Egypt.
Abstract: Tumour lysis syndrome (TLS) is a life-threatening oncological emergency characterized by metabolic abnormalities including hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia. These metabolic complications predispose the cancer patient to clinical toxicities including renal insufficiency, cardiac arrhythmias, seizures, neurological complications and potentially sudden death. TLS is a well-recognized complication of acute lymphoblastic leukemia (ALL). The ability to predict children at differing risk of TLS would be an early step toward risk-based approaches. However with the increased availability of newer therapeutic targeted agents, there are no published guidelines on the risk classification of TLS for individual patients at risk of developing this syndrome. Risk factors included biological evidence of laboratory TLS, proliferation, bulk and stage of malignant tumour and renal impairment at the time of TLS diagnosis. The objectives of the current study were to describe a sensitive prediction rule to identify patients at risk of TLS in childhood ALL. Sixty children aged ≤18 years who were diagnosed as ALL were studied. TLS was defined by the presence of ≥2 laboratory abnormalities occurring in the time of interest (before and 5 days after intiation of chemotherapy). From the total 60 patients include, 45% met criteria for TLS. TLS predictive factors were male sex (odds ratio [OR], 3.0; P = 0.08), age ≥10 years (OR, 1.3; P < 0.2), splenomegaly (OR, 4.2; P = 0.008), generalized lymphadenopathy (OR, 1.0; P =0.2), white blood count (WBC) ≥20 × 109/L (P= < .0001), T-cell phenotype (OR, 8.0; P= 0.002), and lactate dehydrogenase ≥1000 U/L (OR, 5.0; P .002). In conclusion, children with ALL who are at low risk for TLS can be identified early at the time of hospital presentation and may benefit from a risk-stratified approach directed at reduced intensity of laboratory monitoring and limited TLS prophylactic measures.
[Hesham A. Abdel-Baset, Eman Nasr Eldin, Azza A. Eltayeb, Almontaser M. Hussein. Clinical and laboratory approach for the identification of the risk for tumour lysis syndrome in children with acute lymphoblastic leukemia. Life Sci J 2012;9(1):189-195] (ISSN: 1097-8135). http://www.lifesciencesite.com. 27
Key words: Tumour lysis syndrome; hyperuricaemia; hyperphosphataemia; hyperkalaemia; hypocalcaemia.