Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome

Authors

  • Tony H. Truong MD,

    1. Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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  • Joseph Beyene PhD,

    1. Program in Child Health Evaluative Sciences, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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  • Johann Hitzler MD,

    1. Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
    2. Program in Developmental Biology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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  • Oussama Abla MD,

    1. Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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  • Anne Marie Maloney RN, MSN, ACNP,

    1. Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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  • Sheila Weitzman MB, BCh,

    1. Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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  • Lillian Sung MD, PhD

    Corresponding author
    1. Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
    2. Program in Child Health Evaluative Sciences, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
    • Division of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
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    • L.S. is supported by a Career Development Award with the Canadian Child Health Clinician Scientist Training Program, a strategic training program of the Canadian Institutes of Health Research.

    • Fax: (416) 813-5327


Abstract

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 × 109/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 × 109/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. Cancer 2007. © 2007 American Cancer Society.

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