Outcome of Tumor Lysis Syndrome with Hydration and Alkalinization in Children with Acute Lymphoblastic Leukemia

Afiqul Islam,Armin Sultana,Gulshan Akhtar,Md Abdur Rahman

doi:10.3329/bjms.v11i4.12598

Abstract

Objective: To observe the out come of tumor lysis syndrome (TLS) following treatment with hydration and alkalinization in children with acute lymphoblastic leukemia.Methodology: This is an observational study which included 30 diagnosed ALL children who were at high risk of developing TLS in the Department of Pediatric Hematology & Oncology, BSMMU, from January 2010 to July 2010. Result: The mean (±SD) age was found 10.2±2.9 years and maximum (46.7%) numbers were found between 11 to 15 years. Male female ratio was 2.3:1. High risk patients for developing TLS presented with huge organomegaly such as hepatomegaly, splenomegaly, and lymphadenopathy associated with fever, anemia, and bony tenderness. For diagnosis of Acute Lymphoblastic Leukemia (ALL) bone marrow study was done in all patients and immunophenotyping in 40.0% patients. Hydration, Alkalinization, Tab Allopurinol and Oral Aluminum hydroxide were used in all study patients while treatment. WBC and serum uric acid were found higher in all patients during baseline investigation. After hydration and Alkalinization serum potassium, serum phosphate, serum calcium and serum creatinine level were normal within 72 hours and serum uric acid within day five. Mortality was found 6.7% and the cause of mortality was septicemia. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12598 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12

Highlights

Tumor lysis syndrome (TLS) is a potentially life threatening complication of massive cellular lysis in rapidly proliferating bulky, or highly chemo-radio sensitive cancer cells
The results indicate that despite all preventive measures, tumor lysis syndrome still occurs in children following chemotherapy
A total of 30 children diagnosed as a case of Acute Lymphoblastic Leukemia (ALL) who are developing TLS, age ranging from 1 to 15 years were enrolled in the study, in the Department of Pediatric Hematology & Oncology, BSMMU, Dhaka, during January 2010 to July 2010

Summary

Introduction

Tumor lysis syndrome (TLS) is a potentially life threatening complication of massive cellular lysis in rapidly proliferating bulky, or highly chemo-radio sensitive cancer cells. It is a group of metabolic complication that occurs after treatment of cancer, usually lymphomas and leukemia and sometimes even without treatment. These complications are caused by the break-down products of dying cancer cells and include hyperkalemia, hyperphosphatemia, hyperuricemia and hypocalcaemia and consequent acute uric acid nephropathy and acute renal failure. TLS is observed in patients with acute lymphoprolifeatve disorders with high proliferative rate, and high tumor sensitivity to chemotherapy. Risk of TLS based on patient’s characteristics is as follows : High tumor burden-(define as tumor large in size serum lactate dehydrogenase level >1500Iu/L, WBC > 25,000/mm3)

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