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Updated: Jul 12, 2026
Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome
Tony H Truong1, Joseph Beyene, Johann Hitzler
1Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Predicting tumor lysis syndrome (TLS) in children with acute lymphoblastic leukemia (ALL) is crucial. Identifying low-risk patients using clinical and lab features can guide tailored monitoring and prophylaxis strategies.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Prediction Models
Background:
- Tumor lysis syndrome (TLS) is a significant complication in childhood acute lymphoblastic leukemia (ALL).
- Predicting TLS risk aids in developing risk-based management strategies for pediatric ALL patients.
Purpose of the Study:
- To determine the prevalence and predictors of TLS in children diagnosed with ALL.
- To create a sensitive prediction rule for identifying children at lower risk of developing TLS.
Main Methods:
- Retrospective review of health records for children (
- TLS defined by >/=2 laboratory abnormalities within the study timeframe.
- Univariate and multiple logistic regression analyses used to identify TLS predictors.
Main Results:
- 23% of 328 patients met TLS criteria.
- Predictive factors included male sex, age >/=10 years, splenomegaly, mediastinal mass, T-cell phenotype, CNS involvement, high LDH, and high WBC.
- Age >/=10 years, splenomegaly, mediastinal mass, and initial WBC >/=20 x 10(9)/L were independent predictors at presentation.
- In patients lacking these 4 predictors, TLS incidence was low (97% negative predictive value, 95% sensitivity).
Conclusions:
- Clinical and laboratory features at presentation can identify children with ALL at low risk for TLS.
- A risk-stratified approach may allow for reduced TLS monitoring and prophylaxis in these low-risk patients.
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 /=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 < .0001), central nervous system involvement (OR, 2.8; P = .026), lactate dehydrogenase >/=2000 U/L (OR, 7.6; P < .0001), and white blood count (WBC) >/=20 x 10(9)/L (OR, 4.7; P < .0001). Among variables that were available at presentation, multiple regression analysis identified age >/=10 years, splenomegaly, mediastinal mass, and initial WBC >/=20 x 10(9)/L as independent predictors of TLS. When all 4 of those predictors were absent at presentation (n = 114 patients), the negative predictive value of developing TLS was 97%, with a sensitivity of 95%.
Conclusions:
Clinical and laboratory features at the time of presentation identified a group of children with ALL at low risk for TLS that may benefit from a risk-stratified approach directed at reduced TLS monitoring and prophylaxis.
