Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Int J Hematol. 2024 Jun;119(6):660-666. doi: 10.1007/s12185-024-03752-w. Epub 2024 Apr 5.
Guidelines recommend rasburicase for high-risk patients to prevent tumor lysis syndrome (TLS). However, little information is available on the incidence and outcome of TLS in AML patients. We analyzed 145 patients with AML who underwent induction therapy before the approval of rasburicase to evaluate the incidence of TLS and the necessity of rasburicase as prophylaxis. Three patients had already developed clinical TLS (CTLS) at diagnosis of AML, and another three developed CTLS after the initiation of chemotherapy. In patients without TLS at diagnosis of AML, the risk for developing TLS was classified as high in 44 patients, intermediate in 41 and low in 57, according to the current guidelines. Allopurinol alone was administered to prevent hyperuricemia in all patients. All three patients who developed CTLS after diagnosis of AML were at high risk of TLS, and had elevated serum creatinine levels and a WBC count greater than 200,000 per microliter at diagnosis of AML. Allopurinol may be insufficient to prevent TLS in high-risk patients with renal dysfunction at diagnosis of AML, especially those with a high tumor burden and a WBC count of 200,000 or more, which indicates that prophylactic administration of rasburicase should be considered.
指南建议使用拉布立酶预防高危患者肿瘤溶解综合征（TLS）。然而，关于 AML 患者 TLS 的发病率和结局的信息较少。我们分析了 145 例在拉布立酶获批前接受诱导治疗的 AML 患者，以评估 TLS 的发病率和拉布立酶作为预防用药的必要性。3 例 AML 诊断时已发生临床 TLS（CTLS），另有 3 例在化疗开始后发生 CTLS。在 AML 诊断时无 TLS 的患者中，根据目前的指南，44 例患者 TLS 风险为高，41 例为中，57 例为低。所有患者均给予别嘌醇单独预防高尿酸血症。AML 诊断后发生 CTLS 的 3 例患者均为 TLS 高危患者，且 AML 诊断时血清肌酐水平升高和白细胞计数大于 200,000/μL。对于 AML 诊断时肾功能不全的高危患者，别嘌醇可能不足以预防 TLS，尤其是肿瘤负荷高、白细胞计数 200,000 或更高的患者，这表明应考虑预防性使用拉布立酶。
