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Published in: BMC Pediatrics 1/2024

Open Access 01-12-2024 | Tumor Lysis Syndrome | Research

Laboratory and clinical features of tumor lysis syndrome in children with non-Hodgkin lymphoma and evaluation of long-term renal functions in survivors

Authors: Selcen Bozkurt, Dildar Bahar Genc, Sema Vural

Published in: BMC Pediatrics | Issue 1/2024

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Abstract

Objective

The purpose of our study is to investigate the laboratory and clinical features of tumor lysis syndrome (TLS) and acute kidney injury (AKI) in childhood non-Hodgkin lymphomas (NHL) and to reveal their impact on long term kidney function in survivors.

Methods

Our single-center retrospective study included 107 patients (0-18 years old) with NHL who were admitted and treated at our hospital between 1998 and 2020. The relationship between TLS and age, gender, histopathological subgroup, tumor stage, lactate dehydrogenase (LDH) level at presentation, bone marrow and kidney involvement were assessed. The long-term renal functions of the patients were investigated.

Results

80.3% of the patients were male with a median age of 9.8 years. The most common detected histopathological subgroup was Burkitt lymphoma. Hyperhydration with or without alkalinisation, and allopurinol were used in first-line treatment and prophylaxis of TLS. Laboratory TLS and clinical TLS was observed in 30.8% and 12.1% of patients, respectively. A significant correlation was found between young age, advanced stage, high LDH level at presentation, and TLS. AKI was observed in 12.1% of the patients. When the glomerular filtration rate values of the patients at the first and last admissions were compared after an average of 6.9 years, a mean decrease of 10 mL/min/1.73 m2 was found. It was not, however, found to be statistically significant.

Conclusion

Lower age, advanced stage, and high LDH level at presentation were found to be risk factors for TLS in our study. Long-term renal function loss was not observed in the survivors who received early and careful prophylaxis/treatment for TLS. The survivors are still being followed up.
Literature
1.
go back to reference Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127(1):3–11.CrossRefPubMed Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127(1):3–11.CrossRefPubMed
2.
go back to reference La Spina M, Puglisi F, Sullo F, Venti V, Cimino C, Bellia F, et al. Tumor lysis syndrome: an emergency in pediatric oncology. J Pediatr Biochem. 2016;05(04):161–8.CrossRef La Spina M, Puglisi F, Sullo F, Venti V, Cimino C, Bellia F, et al. Tumor lysis syndrome: an emergency in pediatric oncology. J Pediatr Biochem. 2016;05(04):161–8.CrossRef
3.
go back to reference Cheung WL, Hon KL, Fung CM, Leung AK. Tumor lysis syndrome in childhood malignancies. Drugs Context. 2020;9. Cheung WL, Hon KL, Fung CM, Leung AK. Tumor lysis syndrome in childhood malignancies. Drugs Context. 2020;9.
4.
go back to reference Belay Y, Yirdaw K, Enawgaw B. Tumor lysis syndrome in patients with hematological malignancies. J Oncol. 2017;2017. Belay Y, Yirdaw K, Enawgaw B. Tumor lysis syndrome in patients with hematological malignancies. J Oncol. 2017;2017.
5.
go back to reference Leung KKY, Hon KL, Hui WF, Leung AK, Li CK. Therapeutics for paediatric oncological emergencies. Drugs Context. 2021;10. Leung KKY, Hon KL, Hui WF, Leung AK, Li CK. Therapeutics for paediatric oncological emergencies. Drugs Context. 2021;10.
6.
go back to reference Wössmann W, Schrappe M, Meyer U, Zimmermann M, Reiter A. Incidence of tumor lysis syndrome in children with advanced stage Burkitt’s lymphoma/leukemia before and after introduction of prophylactic use of urate oxidase. Ann Hematol. 2003;82:160–5.CrossRefPubMed Wössmann W, Schrappe M, Meyer U, Zimmermann M, Reiter A. Incidence of tumor lysis syndrome in children with advanced stage Burkitt’s lymphoma/leukemia before and after introduction of prophylactic use of urate oxidase. Ann Hematol. 2003;82:160–5.CrossRefPubMed
7.
go back to reference Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26(16):2767–78.CrossRefPubMed Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26(16):2767–78.CrossRefPubMed
8.
go back to reference Abu-Alfa AK, Younes A. Tumor lysis syndrome and acute kidney injury: evaluation, prevention, and management. Am J Kidney Dis. 2010;55(5):S1–13.CrossRefPubMed Abu-Alfa AK, Younes A. Tumor lysis syndrome and acute kidney injury: evaluation, prevention, and management. Am J Kidney Dis. 2010;55(5):S1–13.CrossRefPubMed
10.
go back to reference Park PG, Hong CR, Kang E, et al. Acute kidney injury in pediatric cancer patients. J Pediatr. 2019;208:243–50.CrossRefPubMed Park PG, Hong CR, Kang E, et al. Acute kidney injury in pediatric cancer patients. J Pediatr. 2019;208:243–50.CrossRefPubMed
11.
go back to reference Skinner R. Nephrotoxicity of cancer treatment in children. Pediatr Health. 2010;4(5):519–38.CrossRef Skinner R. Nephrotoxicity of cancer treatment in children. Pediatr Health. 2010;4(5):519–38.CrossRef
12.
go back to reference Skinner R. Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance. Pediatr Nephrol. 2018;33(2):215–25.CrossRefPubMed Skinner R. Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance. Pediatr Nephrol. 2018;33(2):215–25.CrossRefPubMed
14.
go back to reference Sutherland SM, Kwiatkowski DM. Acute kidney injury in children. Adv Chronic Kidney Dis. 2017;24(6):380–7.CrossRefPubMed Sutherland SM, Kwiatkowski DM. Acute kidney injury in children. Adv Chronic Kidney Dis. 2017;24(6):380–7.CrossRefPubMed
15.
go back to reference Mammen C, Al Abbas A, Skippen P, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis. 2012;59(4):523–30.CrossRefPubMed Mammen C, Al Abbas A, Skippen P, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis. 2012;59(4):523–30.CrossRefPubMed
16.
go back to reference Ehrhardt MJ, Dixon SB, Belsky J, Hochberg J. Late effects and frontline treatment selection for children with non-Hodgkin lymphoma. Best Pract Res Clin Haematol. 2023;101443. Ehrhardt MJ, Dixon SB, Belsky J, Hochberg J. Late effects and frontline treatment selection for children with non-Hodgkin lymphoma. Best Pract Res Clin Haematol. 2023;101443.
17.
go back to reference Tacyildiz N, Çakmak HM, Ünal E, Dinçaslan H, Yılmaz Y, Kartal Ö, et al. Late outcomes in children and adolescents with non-Hodgkin lymphoma: A single-center experience. J Cancer Res Ther. 2022;18(3):712–7.CrossRefPubMed Tacyildiz N, Çakmak HM, Ünal E, Dinçaslan H, Yılmaz Y, Kartal Ö, et al. Late outcomes in children and adolescents with non-Hodgkin lymphoma: A single-center experience. J Cancer Res Ther. 2022;18(3):712–7.CrossRefPubMed
18.
go back to reference Chen J, Peng J, Zheng Y, Li S, Yang P, Wu X, et al. Primary renal lymphoma: a population-based study in the United States, 1980–2013. Sci Rep. 2019;9(1):15125.CrossRefPubMedPubMedCentral Chen J, Peng J, Zheng Y, Li S, Yang P, Wu X, et al. Primary renal lymphoma: a population-based study in the United States, 1980–2013. Sci Rep. 2019;9(1):15125.CrossRefPubMedPubMedCentral
19.
21.
go back to reference Kooijmans EC, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen-den Broeder E, van der Pal HJ, et al. Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev. 2019;(3). Kooijmans EC, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen-den Broeder E, van der Pal HJ, et al. Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev. 2019;(3).
22.
go back to reference Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3). Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3).
23.
go back to reference Cairo MS, Coiffier B, Reiter A, Younes A, Panel TE. 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. Br J Haematol. 2010;149(4):578–86. Cairo MS, Coiffier B, Reiter A, Younes A, Panel TE. 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. Br J Haematol. 2010;149(4):578–86.
24.
go back to reference Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179–84.CrossRefPubMed Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179–84.CrossRefPubMed
25.
go back to reference Tzotzola V, Perez P, Attarbaschi A. European standard clinical practice recommendations for non-Hodgkin lymphoma of childhood and adolescence. 2021. The European Society of Pediatric Oncology, siope.eu, Version 1.0, 04.10.2021, Accessed 27 Sept 2023. Tzotzola V, Perez P, Attarbaschi A. European standard clinical practice recommendations for non-Hodgkin lymphoma of childhood and adolescence. 2021. The European Society of Pediatric Oncology, siope.eu, Version 1.0, 04.10.2021, Accessed 27 Sept 2023.
26.
go back to reference Goldstein SL. Continuous renal replacement therapy: mechanism of clearance, fluid removal, indications and outcomes. Curr Opin Pediatr. 2011;23(2):181–5.CrossRefPubMed Goldstein SL. Continuous renal replacement therapy: mechanism of clearance, fluid removal, indications and outcomes. Curr Opin Pediatr. 2011;23(2):181–5.CrossRefPubMed
27.
go back to reference Jones GL, Will A, Jackson GH, Webb NJ, Rule S, British Committee for Standards in Haematology. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015;169(5):661–671. Jones GL, Will A, Jackson GH, Webb NJ, Rule S, British Committee for Standards in Haematology. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015;169(5):661–671.
33.
go back to reference Seidemann K, Meyer U, Jansen P, et al. Impaired renal function and tumor lysis syndrome in pediatric patients with non-Hodgkin’s lymphoma and B-ALL. Klin Pädiatr. 1998;210(04):279–84.CrossRefPubMed Seidemann K, Meyer U, Jansen P, et al. Impaired renal function and tumor lysis syndrome in pediatric patients with non-Hodgkin’s lymphoma and B-ALL. Klin Pädiatr. 1998;210(04):279–84.CrossRefPubMed
34.
go back to reference Sevinir BB, Demirkaya M, Baytan B, Güneş AM. Hyperuricemia and tumor lysis syndrome in children with non-Hodgkin’s lymphoma and acute lymphoblastic leukemia. 2011. Sevinir BB, Demirkaya M, Baytan B, Güneş AM. Hyperuricemia and tumor lysis syndrome in children with non-Hodgkin’s lymphoma and acute lymphoblastic leukemia. 2011.
35.
go back to reference Gopakumar KG, Seetharam S, Km JK, et al. Risk-based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource-limited setting. Pediatr Blood Cancer. 2018;65(12):e27401.CrossRefPubMed Gopakumar KG, Seetharam S, Km JK, et al. Risk-based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource-limited setting. Pediatr Blood Cancer. 2018;65(12):e27401.CrossRefPubMed
36.
go back to reference Micho H, Mohammed Y, Hailu D, Genet S. Evaluation and characterization of tumor lysis syndrome before and after chemotherapy among pediatric oncology patients in Tikur Anbessa specialized hospital, Addis Ababa. Ethiopia BMC Hematol. 2018;18:1–7. Micho H, Mohammed Y, Hailu D, Genet S. Evaluation and characterization of tumor lysis syndrome before and after chemotherapy among pediatric oncology patients in Tikur Anbessa specialized hospital, Addis Ababa. Ethiopia BMC Hematol. 2018;18:1–7.
37.
go back to reference Davidson MB, Thakkar S, Hix JK, Bhandarkar ND, Wong A, Schreiber MJ. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med. 2004;116(8):546–54.CrossRefPubMed Davidson MB, Thakkar S, Hix JK, Bhandarkar ND, Wong A, Schreiber MJ. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med. 2004;116(8):546–54.CrossRefPubMed
38.
go back to reference 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 Recherche en R éanimation Respiratoire et O nco-H ématologique. Br J Haematol. 2013;162(4):489–497. 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 Recherche en R éanimation Respiratoire et O nco-H ématologique. Br J Haematol. 2013;162(4):489–497.
39.
go back to reference Mansoor R, Saeed H, Wali RM, Rehman P, Abubakar M. Malnutrition, sepsis, and tumor lysis syndrome are associated with increased rate of acute mortality in mature B cell non-hodgkin lymphoma in a pediatric population-study from Tertiary Care Hospital in Pakistan. Mediterr J Hematol Infect Dis. 2019;11(1). Mansoor R, Saeed H, Wali RM, Rehman P, Abubakar M. Malnutrition, sepsis, and tumor lysis syndrome are associated with increased rate of acute mortality in mature B cell non-hodgkin lymphoma in a pediatric population-study from Tertiary Care Hospital in Pakistan. Mediterr J Hematol Infect Dis. 2019;11(1).
40.
go back to reference Minard-Colin V, Brugières L, Reiter A, et al. Non-Hodgkin lymphoma in children and adolescents: progress through effective collaboration, current knowledge, and challenges ahead. J Clin Oncol. 2015;33(27):2963.CrossRefPubMedPubMedCentral Minard-Colin V, Brugières L, Reiter A, et al. Non-Hodgkin lymphoma in children and adolescents: progress through effective collaboration, current knowledge, and challenges ahead. J Clin Oncol. 2015;33(27):2963.CrossRefPubMedPubMedCentral
Metadata
Title
Laboratory and clinical features of tumor lysis syndrome in children with non-Hodgkin lymphoma and evaluation of long-term renal functions in survivors
Authors
Selcen Bozkurt
Dildar Bahar Genc
Sema Vural
Publication date
01-12-2024

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