Risk factors and fluid management in tumor lysis syndrome of acute myeloid leukemia: A retrospective study

Current tumor lysis syndrome (TLS) risk stratification for acute myeloid leukemia (AML) is insufficient. This retrospective study included 191 AML patients undergoing induction chemotherapy to identify TLS predictors and evaluate fluid management's impact. TLS occurred in 44 (23.1%) patients, 82% within 72 h post-treatment, with severe cases peaking at 12-24 h. Multivariable and LASSO analyses identified independent risk factors: male gender (OR=3.28, p = 0.025), higher blast percentage (OR=1.03, p = 0.006), elevated baseline uric acid (OR=1.01, p = 0.011), IDH1/2 mutation (OR=4.86, p = 0.005), and a trend with venetoclax-based therapy (OR=7.52, p = 0.072). Higher baseline calcium was protective (OR=0.03, p = 0.025). Adequate urine output reduced TLS risk, while excessive positive fluid balance correlated with severe TLS (p = 0.046). Individualized fluid management and 72-hour intensive monitoring are critical for high-risk groups.