A Study of Clinical Features of Acute Tumor Lysis Syndrome in Children

ABSTRACT

PURPOSE: Tumor lysis syndrome is characterized by hyperuricemia, hyperphosphatemia, hypetkalemia and hypocalcemia due to destruction of tumor cells. The purpose of this study is bi estimate in children the incidence, onset time, differences in outcomes between hemodialysis and conservative therapy, and predictive factor of tumor lysis syndrome before treatment with chernotherapy. METHODS: Subjects were 108 children who had received induction chemotherapy from January 1993 to December 1998. We reviewed 12 patients who developed turnor lysis syndrorne, and retrospectively analyzed their data on WBC, Hb, platelet, LDH, uric acid, phosphorus, potassiurr., calcium, BUN and creatinine. RESULTS: Tumor lysis syndrome was observed in 12(11.1%) cases. Seven out of 12 patient; (58A%) were in the age group of 6 to 10 years. The incidence of tumor lysis syndrome was 9.4% in acute leukemia, 30.8% in malignant lymphoma and 6.5% in solid tumor. Before chemotherapy, tumor lysis syndrome occurred in 3 cases(25.0%). Nine cases(75.0%) developed after initiation of chemotherapy. LDH was significantly higher in the group with tumor lysis syndrome(2790.8+/-1882.1U/L) than the group without(777.6+/-618.5U/L)(P<0.05). Of 12 patients, there were increased levels of phosphorus and uric acid in 11 cases, creatinine in 9 cases, potassium in 6 cases, and calcium was decreased in 8 cases. There was no death during treatment. Duration of treatment until improvement was longer in the hemodialysis group(7.62.7 days) than in thi conservative therapy group(5.71.5 days). CONCLUSION: Turnor lysis syndrome occurred mostly within 24-48 hours after chernotherapy of acute lymphocytic leukemia and Burkitt's lymphoma. LDH before chemotherapy was helpful in predicting the occurrence of turnor lysis syndrome in children.