论著

儿童血液系统恶性肿瘤并发肿瘤溶解综合征38例临床特点分析

  • 王丹 ,
  • 邵静波 ,
  • 李红 ,
  • 张娜 ,
  • 朱嘉莳 ,
  • 付盼 ,
  • 王真
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  • 上海市儿童医院 上海交通大学医学院附属儿童医院血液科(上海 200040)

收稿日期: 2023-09-05

  网络出版日期: 2024-08-06

基金资助

上海市卫生健康委员会科研课题(20204Y0471)

Clinical analysis of 38 cases of hematological malignancies complicated with tumor lysis syndrome in children

  • Dan WANG ,
  • Jingbo SHAO ,
  • Hong LI ,
  • Na ZHANG ,
  • Jiashi ZHU ,
  • Pan FU ,
  • Zhen WANG
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  • Department of Hematology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200040, China

Received date: 2023-09-05

  Online published: 2024-08-06

摘要

目的 研究儿童肿瘤溶解综合征(TLS)的临床特征和预后情况,为 TLS 的防治提供临床指导。方法 回顾性分析2014年12月1日至2023年3月31日就诊的血液系统恶性肿瘤并发TLS患儿的临床资料,分析其临床特点及预后。结果 共纳入38例TLS患儿,男27例、女11例,中位年龄6.6(2.9~9.9)岁。急性淋巴细胞白血病18例,急性髓系白血病8例,伯基特淋巴瘤12例,其中12例(31.6%)合并肾脏浸润。37例(97.4%)在化疗前24小时至化疗开始后72小时内发生TLS;符合临床TLS 21例,实验室TLS 17例。患儿发生TLS时,主要表现为急性肾损伤(AKI,20例),恶心呕吐(18例),发热(18例),胸闷、低氧血症(12例)。21例患儿因疾病加重转入PICU治疗,共发生3例TLS相关死亡。采用别嘌醇降尿酸16例,采用重组尿酸氧化酶降尿酸22例。与别嘌醇组比较,重组尿酸氧化酶组实验室TLS比例较高,AKI发生率、重症转PICU率较低,差异有统计学意义(P<0.05)。TLS发生前-3 d、TLS发生当日、TLS发生后+1 d、+3 d、+5 d共5个时间点之间别嘌醇组的LDH和尿酸水平,重组尿酸氧化酶组的LDH、尿酸和血肌酐水平差异均有统计学意义(P<0.05)。TLS发生后+1 d、+3 d、+5 d,重组尿酸氧化酶组的尿酸水平均低于别嘌醇组,差异有统计学意义(P<0.05)。结论 高负荷血液肿瘤患者在治疗初期发生TLS风险高,尿酸氧化酶可有效降尿酸,减少AKI的发生,降低重症率,缩短TLS病程。

本文引用格式

王丹 , 邵静波 , 李红 , 张娜 , 朱嘉莳 , 付盼 , 王真 . 儿童血液系统恶性肿瘤并发肿瘤溶解综合征38例临床特点分析[J]. 临床儿科杂志, 2024 , 42(8) : 684 -690 . DOI: 10.12372/jcp.2024.23e0868

Abstract

Objective To study the clinical features and prognosis of tumor lysis syndrome (TLS) in children and provide clinical guidance for the prevention and treatment of TLS. Methods The clinical data of patients with TLS from December 2014 to March 2023 were retrospectively analyzed for their clinical features and prognosis. Results A total of 38 children with TLS were included, 27 males and 11 females, with a median age of 6.6 (2.9-9.9) years.. Among these children, 18 were diagnosed with acute lymphoblastic leukemia, 8 with acute myeloid leukemia, and 12 with Burkitt lymphoma, of which 12 cases (31.6 %) were combined with renal infiltration. 37 cases (97.4 %) developed TLS from 24 hours before chemotherapy to 72 hours after the start of chemotherapy, 21 cases were consistent with clinical TLS, and 17 cases with laboratory TLS. The main manifestations of TLS were acute kidney injury (AKI, 20 cases), nausea and vomiting (18 cases), fever (18 cases), chest tightness, and hypoxemia (12 cases). 21 children were transferred to the PICU for treatment of disease exacerbation, and a total of 3 TLS-related deaths occurred. Uric acid was lowered by allopurinol in 16 cases and by recombinant uric acid oxidase in 22 cases. Compared with the allopurinol group, the recombinant uric acid oxidase group had a higher proportion of laboratory TLS and a lower incidence of AKI and severe transfer to the PICU, with statistically significant differences (P<0.05). The LDH and uric acid levels in the allopurinol group were higher at the five time points of -3 d before the onset of TLS, the same day of TLS, and +1 d, +3 d, and +5 d after TLS, and the levels in the allopurinol group were higher at the five time points of -1 d, +1 d, +3 d, and +5 d after TLS. The difference between the LDH, uric acid and blood creatinine levels in the recombinant uric acid oxidase group was statistically significant (P<0.05). The uric acid levels in the recombinant uric acid oxidase group were lower than those in the allopurinol group at +1 d, +3 d and +5 d after the onset of TLS, and the difference was statistically significant (P<0.05). Conclusion Patients with high-load hematological tumors have a high risk of TLS at the early stage of treatment, and uric acid oxidase can effectively lower uric acid, reduce the occurrence of AKI, lower the rate of severe disease, and shorten the duration of TLS.

参考文献

[1] Durani U, Shah ND, Go RS. In-hospital outcomes of tumor lysis syndrome: a population-based study using the national inpatient sample[J]. Oncologist, 2017, 22(12): 1506-1509.
[2] Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification[J]. Br J Haematol, 2004, 127(1): 3-11.
[3] Howard SC, Jones DP, Pui CH. The tumor lysis syndrome[J]. N Engl J Med, 2011, 364(19): 1844-1854.
[4] 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.
[5] Saeed F, Ali MS, Ashraf MS, et al. Tumour lysis syndrome in children with haematological cancers: experience at a tertiary care hospital in Karachi[J]. J Pak Med Assoc, 2018, 68(11): 1625-1630.
[6] Ho M, Zanwar S, Duggan P, et al. Hiding in (not so) plain sight: spontaneous tumor lysis syndrome due to intravascular large B cell lymphoma[J]. Am J Hematol, 2022, 97(1): 151-159.
[7] Teachey DT, Pui CH. Comparative features and outcomes between paediatric T-cell and B-cell acute lymphoblastic leukaemia[J]. Lancet Oncol, 2019, 20(3): e142-e154.
[8] Tambaro FP, Wierda WG. Tumour lysis syndrome in patients with chronic lymphocytic leukaemia treated with BCL-2 inhibitors: risk factors, prophylaxis, and treatment recommendations[J]. Lancet Haematol, 2020, 7(2): e168-e176.
[9] Belay Y, Yirdaw K, Enawgaw B. Tumor lysis syndrome in patients with hematological malignancies[J]. J Oncol, 2017, 2017: 9684909.
[10] Khalighi PR, Martens KL, White AA, et al. Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification[J]. J Oncol Pharm Pract, 2020, 26(3): 529-535.
[11] 中国抗癌协会小儿肿瘤专业委员会. 儿童肿瘤溶解综合征诊疗指南[J]. 中国实用儿科杂志, 2021, 36(12): 890-896.
[12] Ejaz AA, Pourafshar N, Mohandas R, et al. Uric acid and the prediction models of tumor lysis syndrome in AML[J]. PLoS One, 2015, 10(3): e0119497.
[13] Rosner MH, Dalkin AC. Onco-nephrology: the patho-physiology and treatment of malignancy-associated hypercalcemia[J]. Clin J Am Soc Nephrol, 2012, 7(10): 1722-1729.
[14] Cairo MS, Thompson S, Tangirala K, et al. A clinical and economic comparison of rasburicase and allopurinol in the treatment of patients with clinical or laboratory tumor lysis syndrome[J]. Clin Lymphoma Myeloma Leuk, 2017, 17(3): 173-178.
[15] Hu S, Han Y, Zhang W, et al. Cost-effectiveness analysis of rasburicase over standard of care for the prevention and treatment of tumor lysis syndrome in children with hematologic malignancies in China[J]. J Med Econ, 2019, 22(8): 742-750.
[16] Malard F, Mohty M. Acute lymphoblastic leukaemia[J]. Lancet, 2020, 395(10230): 1146-1162.
[17] Botta L, Gatta G, Capocaccia R, et al. Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): Results from a population-based study[J]. Lancet Oncol, 2022, 23(12): 1525-1536.
[18] Abdel-Nabey M, Chaba A, Serre J, et al. Tumor lysis syndrome, acute kidney injury and disease-free survival in critically ill patients requiring urgent chemotherapy[J]. Ann Intensive Care, 2022, 12(1): 15.
[19] Canet E, Cheminant M, Zafrani L, et al. Plasma uric acid response to rasburicase: early marker for acute kidney injury in tumor lysis syndrome?[J]. Leuk Lymphoma, 2014, 55(10): 2362-2367.
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