Risk factors of tumor lysis syndrome in childhood acute lymphoblastic leukemia
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Abstract
Background
Acute lymphoblastic leukemia (ALL) is the most common childhood hematologic malignancy. Treatment failure in ALL can be caused by severe and life-threatening complications, including tumor lysis syndrome (TLS). Delay in identifying risk factors and establishing the diagnosis of TLS by clinicians can be fatal. This study aimed to determine the risk factors for TLS in children with ALL.
Methods
This was a retrospective cross-sectional study on 81 children aged 0 to 18 years with ALL. Tumor lysis syndrome comes in two forms: laboratory and clinical. Laboratory TLS occurs if uric acid levels >normal values, potassium >6mEq/L, phosphate >6.5mg/dl, and calcium <7mg/dl. Clinical TLS includes an increase in serum creatinine, the presence of heart attacks, sudden death, and seizures. Risk factors for TLS include age, nutritional status, leukocyte count, presence of organ infiltration, presence of mediastinal mass, uric acid level, renal function, and type of chemotherapy regimen. Risk factors were analyzed using simple and multiple logistic regression analyses. A value of p<0.05 indicates a significant risk factor.
Results
Twenty seven patients (33.3%) experienced TLS. Adjusted OR analysis showed that the presence of organ infiltration (aOR 5.42; 95% CI 1.45-20.27; p=0.012), leukocyte count (aOR 8.70; 95% CI 1.67-45.13; p=0.010), and decreased kidney function (aOR 12.21; 95% CI 1.09-136.89; p=0.042) were significant risk factors for TLS.
Conclusion
Decreased renal function, leukocyte count, and organ infiltration were significant risk factors for TLS. We suggest more vigilant assessment and monitoring to recognize and treat those patients who are at risk of TLS.
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References
Budiarto, A. Faktor risiko gangguan ginjal pada anak dengan leukemia limfoblastik akut yang mendapatkan protokol kemoterapi Indonesian protocol acute lymphoblastic leukemia (ALL) 2013 selama fase induksi dan konsolidasi. [dissertation]. Universitas Airlangga, Surabaya; 2019.
Belay Y, Yirdaw K, Enawgaw B. Tumor lysis syndrome in patients with hematological malignancies. J Oncol 2017;2017:9684909. doi: 10.1155/2017/9684909.
Russell TB, Kram DE. Tumor lysis syndrome. Pediatr Rev 2020;41:20–6. doi: 10.1542/pir.2018-0243.
Naeem B, Moorani KN, Anjum M, Imam U. Tumor lysis syndrome in pediatric acute lymphoblastic leukemia at tertiary care center. Pak J Med Sci 2019;35:899-904. doi: 10.12669/pjms.35.4.715.
Xue Y, Chen J, Gao S, et al. Clinical characteristics of tumor lysis syndrome in childhood acute lymphoblastic leukemia. Sci Rep 2021;11:1–9. doi: 10.1038/s41598-021-88912-2.
Cheung WL, Hon KL, Fung CM, Leung AK. Tumor lysis syndrome in childhood malignancies. Drugs in context 2020:9:2019-8-2. doi: 10.7573/dic.2019-8-2
Bahoush GR, Yazdi E, Ansari SH, Arjmandi KH, Vossough P. Identification of children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome. J Blood Disord Transfus 2015;6:6. doi: 10.4172/2155-9864.1000318
Cairo MS, Coiffier B, Reiter A, Younes A; TLS Expert Panel. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol 2010;149:578-86. doi:10.1111/j.1365-2141.2010.08143.x
Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 2004;127:3–11. doi: 10.1111/j.1365-2141.2004.05094.x.
Atri SK, Devi E, Homdutt Kumar S, Singh BP. Prevalence of tumor lysis syndrome in acute leukemia and lymphoreticular malignancies: a regional study from PGIMS, Rohtak. J Med Sci Clin Res 2021:9;72-80. doi: 10.18535/jmscr/v9i3.16.
Alakel N, Middeke JM, Schetelig J, Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther 2017;10:597-605. doi:10.2147/OTT.S103864.
Ajmal MU, Saleem R, Saad Ur Rehman SU, Arslan M, Malik I. Spontaneous tumor lysis syndrome in pediatric patients: a case series. Anaesth Pain Intensive Care 2024;28:372−5; doi: 10.35975/apic.v28i2.2409 .
Mansoor R, Saeed H, Wali RM, Rehman P, Abubakar M. Malnutrition, sepsis, and tumor lysis syndrome are associated with increased rate of acute mortality in mature B cell non-Hodgkin lymphoma in a pediatric population - study from tertiary care hospital in Pakistan. Mediterr J Hematol Infect Dis 2019;11:1–7. doi: 10.4084/MJHID.2019.043.
Jones GL, Will A, Jackson GH, Webb NJA, Rule S. Guidelines for managing tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol 2015;169:661–71. doi: 10.1111/bjh.13403.
Hesham AAB, Eman NE, Azza AE, Almontaser MH. Clinical and laboratory approach for the identification of the risk for tumour lysis syndrome in children with acute lymphoblastic leukemia. Life Science J 2012; 9:189-95.
Elkhatib LH, Bayoumy MS, Ahmed AM, Alam MM, Abosoudah IF, Altrabolsi HA. Tumor lysis syndrome in pediatric patients with hematological malignancies. J Appl Hematol 2022;13:118-25. doi: 10.4103/joah.joah_243_20
Arnaud M, Loiselle M, Vaganay C, et al. Tumor lysis syndrome and AKI: beyond crystal mechanisms. J Am Soc Nephrol 2022;33:1154-71. doi:10.1681/ASN.2021070997
Lupusoru G, Ailincai I, Fratila G, et al. Tumor lysis syndrome: an endless challenge in onco-nephrology. Biomedicines 2022;10:1012. doi: 10.3390/biomedicines10051012
Sury, K. Update on the prevention and treatment of tumor lysis syndrome. J Onco-Nephrol 2019;3:19–30. doi: 10.1177/2399369319837212.
Hariharan U, Natarajan V. Critical care management and newer therapies for tumour lysis syndrome. J Blood Lymph 2017;7:189. doi: 10.4172/2165-7831.1000189.