Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome

Abstract

BACKGROUND. Tumor lysis syndrome (TLS) is a well-recognized complication of acute lymphoblastic leukemia (ALL). The ability to predict children at differing risk of TLS would be an early step toward risk-based approaches. The objectives of the current study were 1) to describe the prevalence and predictors of TLS in childhood ALL and 2) to develop a sensitive prediction rule to identify patients at lower risk of TLS. METHODS. Health records of children aged ≤18 years who were diagnosed with ALL between 1998 and 2004 were reviewed. TLS was defined by the presence of ≥2 laboratory abnormalities occurring in the time frame of interest. Predictors of TLS were determined using univariate and multiple logistic regression analyses. RESULTS. Among 328 patients, 23% met criteria for TLS. Factors predictive of TLS were male sex (odds ratio [OR], 1.8; P = .041), age ≥10 years (OR, 4.5; P < .0001), splenomegaly (OR, 3.3; P < .0001), mediastinal mass (OR, 12.2; P < .0001), T-cell phenotype (OR, 8.2; P