Hyperuricemia and tumor lysis syndrome in children with non-Hodgkin's lymphoma and acute lymphoblastic leukemia / Non-Hodgkin lenfoma ve akut lenfoblastik losemili cocuklarda hiperurisemi ve tumor lizis sendromu
Objective: This study aimed to examine the incidence, clinical characteristics, and outcome of hyperuricemia and tumor lysis syndrome (TLS) in children with non-Hodgkin's lymphoma (NHL) and acute lymphoblastic leukemia (ALL).
Materials and Methods: This retrospective study included data from 327 patients (113 NHL and 214 ALL).
Results: Hyperuricemia occurred in 26.5% and 12.6% of the patients with NHL and ALL, respectively. The corresponding figures for TLS were 15.9% and 0.47% (p=0.001). All hyperuricemic NHL patients had advanced disease and renal involvement was present in 53%. All hyperuricemic ALL patients had a leukocyte count >50,000 [mm.sup.3] at the time of diagnosis. Among the hyperuricemic NHL and ALL patients, 96.6% and 66.6% had LDH [greater than or equal to]500 UI/L, respectively. Treatment consisted of hydration and allopurinol; none of the patients received urate oxidase. Among the patients that developed TLS, 26.3% had laboratory TLS, 42.1% had grade I or II TLS, and 31.6% had grade III or IV TLS. Uric acid levels returned to normal after a mean period of 3.5[+ or -]2.5 and 3.05[+ or -]0.8 d in NHL and ALL groups, respectively. In all, 7% of the patients with hyperuricemia required hemodialysis. None of the patients died.
Conclusion: In this series the factors associated with a high-risk for TLS were renal involvement in NHL and high leucocyte count in ALL. Management with allopurinol and hydration was effective in this group of patients with high tumor burden. ("Turk J Hernatol 2011; 28: 52-9)
Key words: Non-Hodgkin's lymphoma, leukemia, tumor lysis syndrome, hyperuricemia, children
Received: January 28, 2010
Accepted: April 30, 2010
Amac: Calismanin amaci NHL ve ALL'li cocuklarda hiperurisemi ve TLS sikligini, klinik ozellikleri ve sonuclarini tanimlamaktir.
Yontem ve Gerecler: Bu retrospektif calismada 113 NHL ve 214 ALL'li toplam 327 hastanin verileri degerlendirildi.
Bulgular: NHL olgulanrun %26.5'inde, ALL olgulannm %12.6'sinda hiperurisemi goruldu. TLS insidansi NHL ve ALL gruplannda %15.9 ve %0.47 bulundu (p=0.001). Hiperurisemi gortilen NHL olgularinin tumu ileri evrede olup, %53'unde renal tutulum vandi. Tum hiperurisemili ALL olgulannda tanida lokosit sayimi 50.000/[mm.sup.3] den yuksekti. Hiperurisemik NHL grubunun %96.6'smda, ALL grubunun %66.6'sinda LDH [greater than or equal to]500 UI/L idi. Tedavide hidrasyon ve allopfurinol uygulandi, urat oksidaz verilen hasta olmadi. TLS gelisen olgularin %26.3'unde laboratuvar TLS, %42,1'inde grade I ve grade II TLS, %31.6'sinda grade III ve IV TLS saptandi. Urik asit duzeyleri NHL ve ALL hastalarinda ortalama 3.5 [+ or -]2.5 ve 3.05[+ or -]0.8 gunde normale dondu. Hiperurisemili hastalrin %7'sinde hemodiyaliz gerekti. Mortalite olmadi.
Sonuc: Bu seride en yuksek TLS riski renal tutulumu olan NEIL olgularinda saptandi. Allopurinol ve hidrasyonun tumor yuku yuksek olan bu grupta etkili oldugu gozlendi. (Turk J Hematol 2011; 28: 52-9)
Anahtar kelimeler: Non-Hodgkin lenfoma, losemi, tumor lizis sendromu, hiperurisemi, coculkar
Gelis tarihi: 28 Ocak 2010
Kabul tarihi: 30 Nisari 2010
Tumor lysis syndrome (TLS) is a complication of cancers that are highly sensitive to cytotoxic agents, and have a high tumor burden and proliferation rate. Acute renal injury may ensue due to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Uric acid is an...
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