Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome.
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.
Truong
Tony H
TH
Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Beyene
Joseph
J
Hitzler
Johann
J
Abla
Oussama
O
Maloney
Anne Marie
AM
Weitzman
Sheila
S
Sung
Lillian
L
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011237:Predictive Value of Tests; D012074:Remission Induction; D012307:Risk Factors; D015275:Tumor Lysis Syndrome / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy