Title: Prevalence of Tumor Lysis Syndrome in Acute Leukemia and Lymphoreticular Malignancies: A Regional Study from PGIMS, Rohtak
Authors: Sudhir Kumar Atri, Ekta Devi, Homdutt, Shiv Kumar, Bhanu Pratap Singh
DOI: https://dx.doi.org/10.18535/jmscr/v9i3.16
Abstract
Objectives: This study was conducted to determine the prevalence of tumor lysis syndrome (TLS) in patients of acute leukemia and lymphoreticular malignancies (Lymphoma).
Materials and Methods: The present study was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak and data was collected bynon-probability convenient sampling from hundred patients (age 14 years or above) of Acute Leukemia or Lymphoma in Haematology Department of Medicine over a period of one year. Patients satisfying inclusion criteria were monitored for development of tumor lysis syndrome. Starting from day of admission till completion of 4 weeks of induction therapy in leukemia patients following parameters (Serum Uric Acid, Serum Potassium, Serum Phosphorus, Serum Calcium, Blasts and TLC) were monitored on alternate day to see for development of TLS. Starting from day of admission, monitoring of same parameters was done on day 1 and day 2of each cycle of lymphoma patients for TLS. If Tumor Lysis Syndrome developed (Grade II or more) then monitoring was done on each day till remission. All patients received adequate hydration, allopurinol and induction chemotherapy. Data were analysed by statistical package for social sciences (SPSS) version16.0.
Results: Out of 100 patients 19 fulfilled the criteria for TLS.In acute leukemia group 10 (28.57%) patients developed TLS of which 5 patients (14.3%) had spontaneous tumor lysis syndrome, 4 patients (11.4%) had laboratory tumor lysis syndrome and only one patient (2.9%) had clinical tumor lysis syndrome. Among lymphoma group no patient developed spontaneous or clinical tumor lysis syndrome. Only laboratory tumor lysis syndrome was seen in 9 (13.8%) out of 65 patients of lymphoma. Overall one patient died because of TLS. Hyperuricemia and Hyperkalemia were the most prominent findings in patients with tumor lysis syndrome.
Conclusion: It is concluded that 19% of the patients developed TLS (including both laboratory and clinical TLS) and despite all measures of prevention it can occur and result in devastating clinical effects.
Keywords: Tumor lysis syndrome, hyperuricemia, hyperphosphatemia, hypocalcaemia, acute renal failure.
References
- Cairo M, Coiffier B, Reiter A, Younes A. Recommendations forthe evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases : An expert TLS panel consensus. British Journal Of Haematology. 2010; 149(4):578-86.
- Krishnan G, D’silva K, Al-Janadi A. Cetuximab related tumourlysis syndrome in metastatic colon carcinoma. Journal of clinical oncology. 2008;26(14):2406-8.
- Joshita S, Yoshizava K, Sano K, Kobayashi S, Sekiguchi T, Morita S et al. A patient with advanced hepatocellular carcinoma treated with sorafenib Tosylate Showed massive tumor lysis with avoidance of tumor lysis syndrome. In ternal medicine. 2010;49(11):991-4.
- Cairo M, Bishop M. Tumor lysis Syndrome: New therapeutic strategies and classification. British Journal Of Haematology. 2004; 127(1):3-11.
- Hande KR, Garrow JC. Acute tumor lysis syndrome with high grade Non-Hodgkin’s Lymphoma. Am J Med. 1993;94(2):133-9
- Wasim F, Khaskheli A. M., Siddiqui A. A., Tariq O., Ansari M. A. Tumor lysis syndrome in haematological malignancies. Journal of the Liaquat University of Mental Health and Sciences. 2012;11(2):84-9
- Darmon M, Vincent F et.al. Groupe. A prospective multicentricstudy from the Groupe de Rechercheen Reanimation Respiratoireet Onco- Hematologique. Br J Haematol.2013 Aug; 162(4): 489-97
- Ejaz AA, Pourafshar N, Mohandas R et al. Uric acid and prediction models of tumor lysis Syndrome in AML. PLoS ONE. 2015;10(3) : e0119497.