Identification of Children with Acute Lymphoblastic Leukemia at Low Risk for Tumor Lysis Syndrome

Abstract

Purpose: We determined the prevalence and predictors of TLS in children with acute lymphoblastic leukemia to develop a sensitive prediction rule to identify low risk patients. Methods: Predictors of TLS were determined in 160 childern with ALL, using univariate and multiple logistic regression analyses. Results: TLS was diagnosed in 41 cases. Univariate analysis showed splenomegaly, mediastinal mass, T-cell phenotype, central nervous system involvement, lactate dehydrogenase ≥2000 U/L, and white blood count (WBC) ≥20 × 109 /L (P<0.001) were predictors of TLS in these cases. Multiple regression analysis of variables identified CNS and renal involvement, mediastinal mass, and initial WBC ≥ 20 × 109 /L as independent predictors of TLS. Conclusions: The above predictors could evaluate the risk of TLS in hematologic malignancies before initiative chemotherapy. Finding a model of independent factors to define a group of ALL children at low risk of TLS could be used to prevent cost of prophylactic treatment modalities.