Risk‐based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource‐limited setting

Gopakumar, K.G.; Seetharam, Shwetha; Krishna, K M Jagathnath; Nair, Manjusha; Rajeswari, Binitha; Cs, Guruprasad; Vr, Prasanth; Thankamony, Priyakumari

doi:10.1002/pbc.27401

Cited by 12 publications

(10 citation statements)

References 42 publications

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“…This was consistent with a previous study listing the risk factor of TLS 8 . Similarly, Gopakumar et al reported children with TLS were likely to be older than those without TLS, although the difference was not significant 11 . Furthermore, ALL patients with TLS had remarkably higher WBC count, which is also aligned with the results in previous studies 8,14 .…”

Section: Discussionmentioning

confidence: 92%

Clinical characteristics of tumor lysis syndrome in childhood acute lymphoblastic leukemia

Xue

Chen

Gao

et al. 2021

Sci Rep

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Tumor lysis syndrome (TLS) is a common and fatal complication of childhood hematologic malignancies, especially acute lymphoblastic leukemia (ALL). The clinical features, therapeutic regimens, and outcomes of TLS have not been comprehensively analyzed in Chinese children with ALL. A total of 5537 children with ALL were recruited from the Chinese Children’s Cancer Group, including 79 diagnosed with TLS. The clinical characteristics, treatment regimens, and survival of TLS patients were analyzed. Age distribution of children with TLS was remarkably different from those without TLS. White blood cells (WBC) count ≥ 50 × 109/L was associated with a higher risk of TLS [odds ratio (OR) = 2.6, 95% CI = 1.6–4.5]. The incidence of T-ALL in TLS children was significantly higher than that in non-TLS controls (OR = 4.7, 95% CI = 2.6–8.8). Hyperphosphatemia and hypocalcemia were more common in TLS children with hyperleukocytosis (OR = 2.6, 95% CI = 1.0–6.9 and OR = 5.4, 95% CI = 2.0–14.2, respectively). Significant differences in levels of potassium (P = 0.004), calcium (P < 0.001), phosphorus (P < 0.001) and uric acid (P < 0.001) were observed between groups of TLS patients with and without increased creatinine. Laboratory analysis showed that older age was associated with a higher level of creatinine. Calcium level was notably lower in males. WBC count, lactate dehydrogenase, and creatinine levels were significantly higher in T-ALL subgroup, whereas procalcitonin level was higher in B-ALL children. Older age, infant, a higher level of WBC and T-ALL were risk factors TLS occurrence. Hyperleukocytosis has an impact on the severity of TLS, while renal injury may be an important feature in the process of TLS.

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Section: Discussionmentioning

confidence: 92%

Clinical characteristics of tumor lysis syndrome in childhood acute lymphoblastic leukemia

Xue

Chen

Gao

et al. 2021

Sci Rep

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“…Although rasburicase is recommended for patients categorized as being at the highest risk of developing TLS, at present, there is still great variability in the use of rasburicase in different countries and regions. A cross-sectional study showed that the utilization rate of rasburicase exposure from 48 children's hospitals throughout the United States was from 7% to 71% [15] and that it is estimated to be even lower in developing countries [16], far from the application recommended by the guidelines [15]. In our institution, 57% of children with haematological malignancies used rasburicase during their ICU stay.…”

Section: Discussionmentioning

confidence: 67%

Evaluation of the safety and efficacy of low-dose rasburicase in critically ill children with haematological malignancies

et al. 2020

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Background The recommended dose of rasburicase is quite expensive, thus limiting its use. Whether a lower dose of rasburicase would be equally effective for critically ill children, who often have more complicated situations and a higher risk of hospital death, is still unknown. Objective To explore the safety and efficacy of low-dose rasburicase in critically ill children with haematological malignancies who are at high risk of tumour lysis syndrome. Setting A single-centre retrospective cohort study. Method Children with haematological malignancies who had a history of rasburicase exposure during an intensive care unit stay were enrolled. Patients were divided into two groups according to the initial dosage of rasburicase: the standard-dose group (> 0.1 mg/kg/day) and the low-dose group (≤ 0.1 mg/kg/day). The adverse events and short-term prognosis of the two groups were compared. Results Thirty-seven children were selected, 22 in the standard-dose group and 15 in the low-dose group. The most common tumour type was Burkitt’s lymphoma (81%), followed by acute lymphoblastic leukaemia (11%). All patients were at high risk of tumour lysis syndrome, and 73% of them had 3 or more tumour lysis syndrome risk factors. The uric acid levels of 90% of patients with hyperuricaemia returned to the normal range within 12 h (100% in the standard-dose group and 75% in the low-dose group, P = 0.083). Eighty-four percent of patients presented serious complications, including tumour lysis syndrome (73%), acute kidney injury (59%), renal replacement treatment (24%), respiratory failure (24%), disseminated intravascular coagulation (16%) and heart failure (11%). There was no significant difference in the incidence of serious complications between the two groups. The overall 7-day and 28-day survival rates after intensive care unit admission were 86% and 84%, respectively. The average length of stay in the intensive care unit was 9.92 ± 5.13 days. Neither the short-term mortality nor the length of stay in the intensive care unit were significantly different between the two groups. Conclusion Low-dose rasburicase is effective and may be an acceptable choice for critically ill children with haematological malignancies.

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“…Importantly, TLS usually occurs in prephase V; all of our patients were carefully evaluated for TLS risk prior to chemotherapy initiation. Patients with high LDH and uric acid levels were at high risk of TLS; thus, they were administered rasburicase or transferred to the intensive care unit and provided supportive hemodialysis for prophylaxis of TLS, in accordance with a previously published approach 15 . One patient experienced TLS and underwent rescue treatment after prephase V; after he achieved complete response, his parents abandoned further chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Burkitt lymphoma with bone marrow involvement or Burkitt leukemia in Chinese children

Zhu

Zhen

Wang

et al. 2021

Pediatric Investigation

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ImportanceBurkitt lymphoma with bone marrow involvement and Burkitt leukemia behave aggressively. Thus far, there are limited data concerning survival and toxicity in Chinese children with Burkitt lymphoma or Burkitt leukemia who have undergone treatment with the non‐Hodgkin’s lymphoma Berlin‐Frankfurt‐Münster‐90/95 (NHL‐BFM‐90/95) protocol.ObjectiveTo analyze outcomes and toxicity in pediatric patients who exhibit Burkitt lymphoma with bone marrow involvement or Burkitt leukemia following treatment with the NHL‐BFM‐90/95 protocol.MethodsPatients aged <18 years with bone marrow involvement/leukemia who were treated with the NHL‐BFM‐90/95 protocol, with or without rituximab, in Sun Yat‐Sen University Cancer Center from April 2004 to December 2018 were included in this retrospective analysis.ResultsTwenty‐five patients were eligible. Burkitt lymphoma with bone marrow involvement and Burkitt leukemia were present in 10 and 15 patients, respectively. Central nervous system infiltration was not observed in any patients. All patients underwent chemotherapy involving NHL‐BFM‐90/95 protocol. Six courses of treatment were administered to each patient (v‐AA‐BB‐CC‐AA‐BB‐CC). The BFM‐90/95 plus rituximab protocol was administered to 13 patients. The median follow‐up interval was 31.9 months (range, 2.5–158 months). Of the 25 patients, four died: three died of tumor progression and one died of therapy abandonment after relief of tumor lysis syndrome. The estimated 5‐year event‐free survival and overall survival rates were both 85.8% ± 5.0%.InterpretationChinese pediatric patients who exhibit Burkitt lymphoma with bone marrow involvement or Burkitt leukemia can achieve optimal treatment outcomes and exhibit good tolerance when using the NHL‐BFM‐90/95 protocol.

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Risk‐based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource‐limited setting

Abstract: With hydration, supportive care and judicious use of rasburicase, it is feasible to manage TLS efficiently in resource-limited settings. A modification of the TLS definition criteria would help to identify clinically relevant TLS.

Cited by 12 publications

References 42 publications

Clinical characteristics of tumor lysis syndrome in childhood acute lymphoblastic leukemia

Clinical characteristics of tumor lysis syndrome in childhood acute lymphoblastic leukemia

Evaluation of the safety and efficacy of low-dose rasburicase in critically ill children with haematological malignancies

Outcomes of Burkitt lymphoma with bone marrow involvement or Burkitt leukemia in Chinese children

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