Medline ® Abstract for Reference 41
of 'Overview of the treatment of acute lymphoblastic leukemia in children and adolescents'
Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome.
Truong TH, Beyene J, Hitzler J, Abla O, Maloney AM, Weitzman S, Sung L
BACKGROUND: Tumor lysis syndrome (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. The objectives of the current study were 1) to describe the prevalence and predictors of TLS in childhood ALL and 2) to develop a sensitive prediction rule to identify patients at lower risk of TLS.
METHODS: Health records of children aged</=18 years who were diagnosed with ALL between 1998 and 2004 were reviewed. TLS was defined by the presence of>/=2 laboratory abnormalities occurring in the time frame of interest. Predictors of TLS were determined using univariate and multiple logistic regression analyses.
RESULTS: Among 328 patients, 23% met criteria for TLS. Factors predictive of TLS were male sex (odds ratio [OR], 1.8; P = .041), age>/=10 years (OR, 4.5; P<.0001), splenomegaly (OR, 3.3; P<.0001), mediastinal mass (OR, 12.2; P<.0001), T-cell phenotype (OR, 8.2; P<.0001), central nervous system involvement (OR, 2.8; P = .026), lactate dehydrogenase>/=2000 U/L (OR, 7.6; P<.0001), and white blood count (WBC)>/=20 x 10(9)/L (OR, 4.7; P<.0001). Among variables that were available at presentation, multiple regression analysis identified age>/=10 years, splenomegaly, mediastinal mass, and initial WBC>/=20 x 10(9)/L as independent predictors of TLS. When all 4 of those predictors were absent at presentation (n = 114 patients), the negative predictive value of developing TLS was 97%, with a sensitivity of 95%.
CONCLUSIONS: Clinical and laboratory features at the time of presentation identified a group of children with ALL at low risk for TLS that may benefit from a risk-stratified approach directed at reduced TLS monitoring and prophylaxis.
Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.