Incidence of tumor lysis syndrome in children with advanced stage Burkitt's lymphoma/leukemia before and after introduction of prophylactic use of urate oxidase

Wößmann, Wilhelm; Schrappe, Martin; Meyer, U; Zimmermann, Martin; Reiter, Alfred

doi:10.1007/s00277-003-0608-2

Cited by 142 publications

(80 citation statements)

References 19 publications

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“…Though there is a wide variation in TLS occurrence across the world, this result is comparable with previous researches that reported 26.5% and 30.7% incidence of TLS respectively [7, 8]. The LTLS and CTLS incidences were 11.5% and 18.0%; similar to 11.1% LTLS and 19.6% CTLS reported from a cohort study by Darmon et al [8] but differs from a report of lower incidence of CTLS (2.9%) in Iran and 6.7% in Saudi Arabia [9, 10].…”

Section: Discussionsupporting

confidence: 89%

Evaluation and characterization of tumor lysis syndrome before and after chemotherapy among pediatric oncology patients in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

et al. 2018

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BackgroundTumor lysis syndrome (TLS) is a life-threatening emergency disorder, caused by an abrupt release of intracellular metabolites after tumor cell death. It is characterized by a series of metabolic manifestations, especially hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. The aim of this study was to evaluate and characterize the incidence of tumor lysis syndrome among pediatric oncology patients before and after treatment.MethodsHospital based prospective cohort study was conducted for 6 months on 61 newly diagnosed pediatric oncology patients. Socio-demographic data was collected by interview administered questionnaire. Patients were followed and the physical diagnosis, imaging and laboratory results were interpreted by senior physicians. Data was entered to and analyzed by SPSS version 23.ResultsAmong 61 pediatric oncology patients 39(63.9%) were males. The mean (±SD) age of the pediatric patients was 6.39 (± 3.67) years ranging from 2 months to 14 years. 29.5% of patients were found to have TLS. There were 11.5% and 18.0% of laboratory TLS (LTLS) and clinical TLS (CTLS) cases respectively. There were72.2% spontaneous and 27.8% treatment induced TLS cases with 23% and 21.3% cases of hyperuricemia and 4.9% and 6.6% cases of hyperkalemia incidence before and after treatment respectively. Only two patients died, in the study period, due to TLS.ConclusionThere was high incidence of TLS irrespective of socio-demographic variation among study participants, suggesting that children with cancer are at risk of developing TLS. As TLS is a life-threatening complication of malignancies, early identification of patients at risk and reducing morbidity and mortality is crucially important.

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Section: Discussionsupporting

confidence: 89%

Evaluation and characterization of tumor lysis syndrome before and after chemotherapy among pediatric oncology patients in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

et al. 2018

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“…More than 1 in 4 children with that malignancy will develop TLS after treatment. 4 Among adults, TLS is commonly seen after treatment for ALL, acute myeloid leukemia, and Burkitt’s lymphoma. 5–7 Although TLS is often associated with cytotoxic chemotherapy, reports exist of TLS occurring after treatment with radiation therapy, 8,9 dexamethasone treatment, 10 thalidomide therapy, 11,12 and with newer chemotherapeutic agents including bortezomib and rituximab.…”

Section: Epidemiologymentioning

confidence: 99%

Tumor Lysis Syndrome: New Challenges and Recent Advances

Wilson

Berns

2014

Advances in Chronic Kidney Disease

167

131

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Tumor lysis syndrome (TLS) is an oncologic emergency triggered by the rapid release of intracellular material from lysing malignant cells. Most common in rapidly growing hematologic malignancies, TLS has been reported in virtually every cancer type. Central to its pathogenesis is the rapid accumulation of uric acid derived from the breakdown of nucleic acids, which leads to kidney failure by various mechanisms. Kidney failure then limits the clearance of potassium, phosphorus, and uric acid leading to hyperkalemia, hyperphosphatemia, and secondary hypocalcemia, which can be fatal. Prevention of TLS may be more effective than treatment, and identification of at-risk individuals in whom to target preventative efforts remains a key research area. Herein, we discuss the pathophysiology, epidemiology, and treatment of TLS with an emphasis on the kidney manifestations of the disease.

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“…As with other TLS models previously published (48, 49), our model may not be generalizable to other diseases and therapies. Rather than modeling a drug exposure-TLS relationship, which may change with each drug therapy, modeling of a biomarker-TLS relationship may be preferred, if such a biomarker could be identified to be rapidly modulated post flavopiridol therapy and correlate with TLS occurrence and either drug or metabolite levels.…”

Section: Discussionmentioning

confidence: 97%

A Pharmacokinetic/Pharmacodynamic Model of Tumor Lysis Syndrome in Chronic Lymphocytic Leukemia Patients Treated with Flavopiridol

Jia

Mould²,

Blum

et al. 2013

Clinical Cancer Research

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Purpose Flavopiridol, the first clinically evaluated cyclin dependent kinase inhibitor, demonstrates activity in patients with refractory chronic lymphocytic leukemia, but prevalent and unpredictable tumor lysis syndrome (TLS) presents a major barrier to its broad clinical use. The purpose of this study was to investigate the relationships between pretreatment risk factors, drug pharmacokinetics, and TLS. Experimental Design A population pharmacokinetic/pharmacodynamic model linking drug exposure and TLS was developed. Plasma data of flavopiridol and its glucuronide metabolite (flavo-G) were obtained from 111 patients treated in early phase trials with frequent sampling following initial and/or escalated doses. TLS grading was modeled with logistic regression as a pharmacodynamic endpoint. Demographics, baseline disease status, and blood chemistry variables were evaluated as covariates. Results Gender was the most significant pharmacokinetic covariate, with females displaying higher flavo-G exposure than males. Glucuronide metabolite exposure was predictive of TLS occurrence, and bulky lymphadenopathy was identified as a significant covariate on TLS probability. The estimated probability of TLS occurrence in patients with baseline bulky lymphadenopathy < 10 cm or > 10 cm during the first two treatments was 0.111 (SE% 13.0%) and 0.265, (SE% 17.9%) respectively, when flavo-G area under the plasma concentration vs. time curve was at its median value in whole patient group. Conclusions This is the first population pharmacokinetic/pharmacodynamic model of TLS. Further work is needed to explore potential mechanisms and to determine if the associations between TLS, gender and glucuronide metabolites are relevant in CLL patients treated with other cyclin dependent kinase inhibitors.

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Incidence of tumor lysis syndrome in children with advanced stage Burkitt's lymphoma/leukemia before and after introduction of prophylactic use of urate oxidase

Cited by 142 publications

References 19 publications

Evaluation and characterization of tumor lysis syndrome before and after chemotherapy among pediatric oncology patients in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

Evaluation and characterization of tumor lysis syndrome before and after chemotherapy among pediatric oncology patients in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

Tumor Lysis Syndrome: New Challenges and Recent Advances

A Pharmacokinetic/Pharmacodynamic Model of Tumor Lysis Syndrome in Chronic Lymphocytic Leukemia Patients Treated with Flavopiridol

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