Pattern of Tumor Lysis Syndrome in Patients with Acute Lymphoblastic Leukemia

Background: Prevention and treatment of tumor lysis syndrome (TLS) depends on immediate recognition of patients at risk. Therefore, we conducted this study to determine the frequency and risk factors of TLS in patients with acute lymphoblastic leukemia (ALL). Objective: The aim of the study was to observe the frequency of Tumor lysis syndrome in patients with Acute Lymphoblastic Leukemia.Material & Methods:This cross-sectional study was conducted at the department of Haematology in Bangabandhu Sheikh Mujib Medical University (BSMMU), over a period of 12 months following approval of this protocol. Total 50 patients admitted with ALL were included in this study after careful history taking, examination and appropriate investigations fulfilling inclusion and exclusion criteria, irrespective of their gender, race, ethnic group and age. Ethical issues were ensured properly. After briefing the aims and objectives and potential risk and benefits, written informed consent was taken from each subject. Interviews were done by investigator herself using separate case record form. After editing and encoding, data was analyzed by computer with the help of SPSS 24.Results:The mean age of patients was 21.24�.83 (SD) years with majority aged less than 20 years (54%) and male gender (62%). Prevalence of TLS was found to be 26% (n=13), wherein spontaneous onset (n=8, 61.54%) and lab TLS (n=9, 69.23%) was more frequent than therapy induced TLS (n=5, 38.46%) and clinical TLS (n=4, 30.77%). The most common biochemical changes occurred within 3 days before chemotherapy and 7 days after initiation of chemotherapy among TLS patients was hyperuricemia (69.23 and 76.92% respectively) and hyperkalaemia (61.54 and 69.23% respectively) with significant differences compared to non-TLS patients (p value <0.05). Initial WBC count and serum LDH of all patients was 52.51�.70 x109/L and 1591.53�95.47 U/L respectively, wherein majority patients with TLS had significantly higher WBC count ?50 x109/L (61.54%) and serum LDH ?1000 U/L (92.31%) compared to non-TLS patients (16.22 and 21.62% respectively, p value <0.05). Multivariate analysis showed that serum LDH ?1000 U/L was the significant independent predictors of developing TLS (OR=13.07, 95% CI: 1.93-101.23).Conclusions:TLS was commonly found in patients with ALL, wherein spontaneous onset and lab TLS was more common than therapy induced TLS and clinical TLS. However, a large multicenter study is needed to corroborate these findings.

Acquired pure red cell aplasia--a case report.

A married female patient of 36 years with chronic anaemia, because of pure erythroid aplasia with a haemolytic component and hypothyroidism due to antithyroid auto-antibodies, was subsequently discovered as a case of systemic lupus erythematosus (SLE). She was treated with corticosteroid and immunosuppressive therapy and her anaemia was corrected. The response of erythroid aplasia to corticosteroid and other immunosuppressive agents suggests that immunological factors play a role in erythroid aplasia in SLE. The occurrence of red cell aplasia in association with a variety of immune phenomenon supports the concept that in SLE, erythroid aplasia may be of immune aetiology.

Chemotherapy of acute myeloblastic leukaemia with DAM regimen.

32 patients of denovo-ANLL were treated with Doxorubicin, Ara-C and 6-Mercaptopurine (DAM) regimen. Remission induction was instituted with 1-3 cycles of DAM regimen and maintenance was given by 6-MP continuously with intermittent DA (1,5) regimen. In the remission induction, Doxorubicin 30 mg/m2 for 3 days, Ara-C 150 mg/m2 for 5 days and 6-Mp 100 mg/m2 daily was given. Complete remission (CR) was observed in 60% cases. The probability of 2 years disease-free survival of patients with complete remission is 56.73%.