Current trends in the diagnosis and treatment of acute tumor lysis syndrome in children: a review

Abstract

INTRODUCTION: Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemia, lymphomas in children and is accompanied by a fatal outcome in 21.4 % of patients. The basis of ATLS is the decay of tumor cells, in which the volume of decay products exceeds the excretory capabilities of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100×109/L) and non-Hodgkin's lymphomas with a large tumor mass (III–IV stages of the disease). To date, the volume of thematic publications in the aggregator of the PubMed medical database is not so large: over the past 10 years, there have been 12 articles, which makes the task of systematizing previously accumulated and recently received information even more relevant for the practitioner. OBJECTIVE: Generalization of the modern scientific base for the diagnosis and treatment of ATLS in children. MATERIALS AND METHODS: To highlight the modern scientific base concerning the diagnosis and treatment of ATLS in children with oncohematological diseases, a search was conducted in PubMed, Research Gate, Web of Science Core Collection and Google Scholar systems for the period from 2000 to August 2022. RESULTS: In total, 94 articles were found, including 1 systematic review with meta-analysis and 16 review articles that meet the requirements. CONCLUSIONS: Conservative ATLS prophylaxis is effective in 93.4–93.6 % of patients. However, in 8.8–21.4 % of patients, ATLS acquires a rapid character, accompanied by the lack of the ability to conservatively correct the indicators of potassium, phosphorus, uric acid. Additional study of the pathogenetic mechanisms of the complication, identification of key targets of drug therapy and a multidisciplinary approach in the treatment of an extremely prognostically unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components of further improving the effectiveness of ATLS therapy.