急性白血病患者肿瘤溶解综合征发病率与危险因素分析
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摘要
目的探讨初诊急性白血病(AL)患者肿瘤溶解综合征(TLS)的发病率和疾病转归及其相关危险因素。方法回顾性分析107例AL患者的临床资料,根据Cairo和Bishop标准判断患者是否发生TLS,并分析发病相关危险因素。结果在107例AL患者中,22例(20.6%)发生TLS。其中,临床TLS(CTLS)1例(0.9%),实验室TLS(LTLS)21例(19.6%)。单因素分析发现,男性、肝脾肿大、淋巴结肿大、血肌酐升高、血尿酸升高、乳酸脱氢酶升高和白细胞数升高均为TLS的发病危险因素。结论 TLS是AL的常见并发症,对高危患者应予密切监测、预防及充分治疗。
Objective To explore the incidence and risk factors for tumor lysis syndrome(TLS)in the patients with acute leukemia(AL).Methods The data of 107 patients newly diagnosed as AL were retrospectively analyzed.The TLS was diagnosed according to the criteria of Cario and Bioshop and the risk factors for TLS were evaluated.Results Of 107 patients with AL,TLS occurred in 22 cases(20.6%)including one case(0.93%)diagnosed as the clinical TLS and 21 cases(19.6%)diagnosed as laboratorial TLS.The univariate analysis showed that male,high WBC count,hepatomegaly or splenomegaly,lymphadenectasis,high creatinine,high uric acid level,and high serum lactate dehydrogenase(LDH)level were the independent risk factors for TLS.Conclusion The TLS is a common complication in the patients with AL.The intensive monitoring,prevention and active treatment should be emphasized in AL patients with high risk factors for TLS.
Objective To explore the incidence and risk factors for tumor lysis syndrome(TLS)in the patients with acute leukemia(AL).Methods The data of 107 patients newly diagnosed as AL were retrospectively analyzed.The TLS was diagnosed according to the criteria of Cario and Bioshop and the risk factors for TLS were evaluated.Results Of 107 patients with AL,TLS occurred in 22 cases(20.6%)including one case(0.93%)diagnosed as the clinical TLS and 21 cases(19.6%)diagnosed as laboratorial TLS.The univariate analysis showed that male,high WBC count,hepatomegaly or splenomegaly,lymphadenectasis,high creatinine,high uric acid level,and high serum lactate dehydrogenase(LDH)level were the independent risk factors for TLS.Conclusion The TLS is a common complication in the patients with AL.The intensive monitoring,prevention and active treatment should be emphasized in AL patients with high risk factors for TLS.
引文
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[7]Coiffier B,Altman A,Pui CH,et al.Guidelines for the management of pediatric and adult tumor lysis syndrome:an evidence-based review[J].J Clin Oncol,2008,26(16):2767-2778.
[8]Patte C,Sakiroglu C,Ansoborlo S,et al.Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia,treated in the SociétéFranaise d′Oncologie Pédiatrique LMB89 protocol[J].Ann Oncol,2002,13(5):789-795.
[9]Annemans L,Moeremans K,Lamotte M,et al.Incidence,medical resource utilisation and costs of hyperuricemia and tumour lysis syndrome in patients with acute leukaemia and non-Hodgkin′s lymphoma in four European countries[J].Leuk Lymphoma,2003,44(1):77-83.
[10]Mato AR,Riccio BE,Qin L,et al.A predictive model for the detection of tumor lysis syndrome during AML induction therapy[J].Leuk Lymphoma,2006,47(5):877-883.
[11]Montesinos P,Lorenzo I,Martin G,et al.Tumor lysis syndrome in patients with acute myeloid leukemia:identification of risk factors and development of a predictive model[J].Haematologica,2008,93(1):67-74.
[12]Darmon M,Vincent F,Camous L,et al.Tumour lysis syndrome and acute kidney injury in high-risk haematology patients in the rasburicase era.A prospective multicentre study from the Groupe de Récherche en Reanimation Respiratoire et Onco-Hématologique[J].Br J Haematol,2013,162(4):489-497.
[13]Cairo MS,Coiffier B,Reiter A,et al.Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome(TLS)in adults and children with malignant diseases:an expert TLS panel consensus[J].Br J Haematol,2010,149(4):578-586.
[2]Will A,Tholouli E.The clinical management of tumour lysis syndrome in haematological malignancies[J].Br J Haematol,2011,154(1):3-13.
[3]O′Donnell MR,Abboud CN,Altman J,et al.Acute myeloid leukemia[J].J Natl Compr Canc Netw,2012,10(8):984-1021.
[4]Cairo MS,Bishop M.Tumour lysis syndrome:new therapeutic strategies and classification[J].Br J Haematol,2004,127(1):3-11.
[5]Flombaum CD.Metabolic emergencies in the cancer patient[J].Semin Oncol,2000,27(3):322-334.
[6]Jeha S.Tumor lysis syndrome[J].Semin Hematol,2001,38(4Suppl 10):4-8.
[7]Coiffier B,Altman A,Pui CH,et al.Guidelines for the management of pediatric and adult tumor lysis syndrome:an evidence-based review[J].J Clin Oncol,2008,26(16):2767-2778.
[8]Patte C,Sakiroglu C,Ansoborlo S,et al.Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia,treated in the SociétéFranaise d′Oncologie Pédiatrique LMB89 protocol[J].Ann Oncol,2002,13(5):789-795.
[9]Annemans L,Moeremans K,Lamotte M,et al.Incidence,medical resource utilisation and costs of hyperuricemia and tumour lysis syndrome in patients with acute leukaemia and non-Hodgkin′s lymphoma in four European countries[J].Leuk Lymphoma,2003,44(1):77-83.
[10]Mato AR,Riccio BE,Qin L,et al.A predictive model for the detection of tumor lysis syndrome during AML induction therapy[J].Leuk Lymphoma,2006,47(5):877-883.
[11]Montesinos P,Lorenzo I,Martin G,et al.Tumor lysis syndrome in patients with acute myeloid leukemia:identification of risk factors and development of a predictive model[J].Haematologica,2008,93(1):67-74.
[12]Darmon M,Vincent F,Camous L,et al.Tumour lysis syndrome and acute kidney injury in high-risk haematology patients in the rasburicase era.A prospective multicentre study from the Groupe de Récherche en Reanimation Respiratoire et Onco-Hématologique[J].Br J Haematol,2013,162(4):489-497.
[13]Cairo MS,Coiffier B,Reiter A,et al.Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome(TLS)in adults and children with malignant diseases:an expert TLS panel consensus[J].Br J Haematol,2010,149(4):578-586.