Tumor lysis syndrome in patients with acute myeloid leukemia: identification of risk factors and development of a predictive model

Montesinos, Pau; Lorenzo, Ignacio; Martı́n, Guillermo; Sanz, Jaime; Pérez-Sirvent, Maria Luz; Martı́nez, David; Ortí, Guillermo; Algarra, Lorenzo; Martı́nez, Jesús; Moscardó, Federico; Rubia, Javier de la; Jarque, Isidro; Sanz, Guillermo; Sanz, Miguel Á.

doi:10.3324/haematol.11575

Cited by 190 publications

(150 citation statements)

References 28 publications

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“…The same pitfalls can be observed in a more recent retrospective study performed in a larger series of adult AML patients. 28 TLS is not a frequent complication in the treatment of adult solid tumors. 29,30 High-risk tumors include cancers known to be highly sensitive to chemotherapy, like bulky small cell lung cancer and metastatic germ cell carcinoma (either gonadal or extragonadal).…”

Section: Recommendationsmentioning

confidence: 99%

Consensus conference on the management of tumor lysis syndrome

Tosi¹,

Barosi²,

Lazzaro³

et al. 2008

Haematologica

123

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Tumor lysis syndrome is a potentially life threatening complication of massive cellular lysis in cancers. Identification of high-risk patients and early recognition of the syndrome is crucial in the institution of appropriate treatments. Drugs that act on the metabolic pathway of uric acid to allantoin, like allopurinol or rasburicase, are effective for prophylaxis and treatment of tumor lysis syndrome. Sound recommendations should regulate diagnosis and drug application in the clinical setting. The current article reports the recommendations on the management of tumor lysis syndrome that were issued during a Consensus Conference project, and which were endorsed by the Italian Society of Hematology (SIE), the Italian Association of Pediatric Oncologists (AIEOP) and the Italian Society of Medical Oncology (AIOM). Current concepts on the pathophysiology, clinical features, and therapy of tumor lysis syndrome were evaluated by a Panel of 8 experts. A consensus was then developed for statements regarding key questions on tumor lysis syndrome management selected according to the criterion of relevance by group discussion. Hydration and rasburicase should be administered to adult cancer patients who are candidates for tumor-specific therapy and who carry a high risk of tumor lysis syndrome. Cancer patients with a low-risk of tumor lysis syndrome should instead receive hydration along with oral allopurinol. Hydration and rasburicase should also be administered to patients with clinical tumor lysis syndrome and to adults and high-risk children who develop laboratory tumor lysis syndrome. In conclusion, the Panel recommended rasburicase for tumor lysis syndrome prophylaxis in selected patients based on the drug efficacy profile. Methodologically rigorous studies are needed to clarify its cost-effectiveness profile.

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Section: Recommendationsmentioning

confidence: 99%

Consensus conference on the management of tumor lysis syndrome

Tosi¹,

Barosi²,

Lazzaro³

et al. 2008

Haematologica

123

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“…Available facts suggest that the incidence of clinical TLS is approximately 3-7% for acute leukemias and 4-11% for lymphomas (Annemans et al, 2003;Wossmann et al, 2003). However certain subgroups of leukemia patients, such as those with mature B acute lymphoblastic leukemia (ALL) and Burkitt's lymphoma/ leukemia, have been reported to have a high frequency of TLS of around 25% (Stapleton et al, 1988;Montesinos et al, 2008). Table 4 summarizes the degrees of risk in patients with a particular type of cancer.…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

Tumour Lysis Syndrome: Implications for Cancer Therapy

Mika¹,

Ahmad²,

Guruvayoorappan³

2012

Asian Pacific Journal of Cancer Prevention

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Asian Pacific J Cancer Prev, 13, 3555-3560 IntroductionTumour lysis syndrome (TLS) is the development of an array of metabolic disturbances that may occur either spontaneously or in response to cancer therapies. It results when a huge number of rapidly dividing cancer cells, particularly leukemia and lymphoma, are killed or lysed by cytotoxic therapy such as chemotherapy and radiation. Normal intracellular components of cells include potassium, phosphorus and nucleic acids. These intracellular ions are present in large amounts in cancer cells as compared to those in normal cells.When malignant cells are killed by therapy they release their contents into the systemic circulation, which accumulate faster in the body than being eliminated from the body and the body's homeostatic mechanisms find it difficult to cope with. The release of these intracellular contents cause metabolic disturbances, which in turn manifest into life threatening complications such as hyperkalemia, hyperphosphotemia, hypocalcemia and hyperuricemia. Tumour lysis also releases cytokines that cause a systemic inflammatory response syndrome and often multiorgan failure (Hijiya et al., 2005;Nakamura et al., 2009;Soares et al., 2009).During the early stages, some patients do not experience any symptoms of TLS but have abnormal laboratory values, which is suggestive of its succession. Laboratory results will show high potassium, uric acid and phosphorus levels and low calcium levels in the blood.

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“…A study at our institution retrospectively examined 194 patients with acute myeloid leukemia, of whom 19 developed clinical or laboratory TLS. In univariate analysis, a strong association was demonstrated between baseline creatinine level and the development of TLS {odds ratio (OR), 31 (33,(37)(38)(39). Table 3 summarizes these additional risks.…”

Section: Identification Of Individuals At Riskmentioning

confidence: 99%

“…The association between renal function and development of TLS is strong and has been seen across a variety of populations and tumor subtypes. A prospective study of 1192 patients with non-Hodgkin lymphoma (of whom 63 developed TLS) revealed preexisting renal dysfunction in 68% of those affected; however, (37). Further studies using estimated GFR rather than creatinine concentration will help to better elucidate differences in risk among varying degrees of kidney function while minimizing potential confounding by sex and race.…”

Section: Effect Of Kidney Functionmentioning

confidence: 99%

Onco-Nephrology

Wilson

Berns

2012

Clinical Journal of the American Society of Nephrology

122

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SummaryTumor lysis syndrome (TLS) describes the clinical and laboratory sequelae that result from the rapid release of intracellular contents of dying cancer cells. It is characterized by the release of potassium, phosphorous, and nucleic acids from cancer cells into the blood stream, with the potential to cause hyperkalemia; hyperphosphatemia and secondary hypocalcemia; hyperuricemia; AKI; and, should usual homeostatic mechanisms fail, death. TLS most commonly follows treatment of hematologic malignancies, such as acute lymphocytic or lymphoblastic leukemia, acute myeloid leukemia, and Burkitt lymphoma, but also occurs after treatment of other bulky or rapidly growing tumors, particularly if the patient is highly sensitive to the effects of cytotoxic chemotherapy. Prevention and treatment depend on prompt recognition of patients at risk, volume repletion, allopurinol, rasburicase (a novel recombinant urate oxidase), and, when indicated, dialysis.

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Tumor lysis syndrome in patients with acute myeloid leukemia: identification of risk factors and development of a predictive model

Cited by 190 publications

References 28 publications

Consensus conference on the management of tumor lysis syndrome

Consensus conference on the management of tumor lysis syndrome

Tumour Lysis Syndrome: Implications for Cancer Therapy

Onco-Nephrology

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