Rowe Margaret, Babushok Daria, Carroll Martin, Carulli Alison, Frey Noelle, Gill Saar, Hexner Elizabeth, Hirsh Rebecca, Hossain Nasheed, Lai Catherine, Loren Alison, Luger Selina, Maillard Ivan, McCurdy Shannon, Matthews Andrew, Martin Mary Ellen, Paralkar Vikram R, Perl Alexander, Porter David, Pratz Keith, Stadtmauer Edward, Bruno Ximena Jordan
Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Eur J Haematol. 2025 Apr;114(4):626-635. doi: 10.1111/ejh.14371. Epub 2024 Dec 26.
Venetoclax with hypomethylating agents (HMA) is the standard of care for acute myeloid leukemia (AML) in patients ineligible for intensive chemotherapy and is associated with tumor lysis syndrome (TLS). TLS prophylaxis and the use of Cairo Bishop versus Howard diagnostic criteria are not standardized. Here we report TLS prophylaxis and incidence in a retrospective cohort of 100 consecutive AML patients treated with venetoclax and HMA. Thirty four patients developed laboratory Cairo Bishop TLS; 8 of these met criteria for clinical Cairo Bishop TLS. Only 6 of patients met Howard TLS criteria. Fourteen patients had spontaneous TLS. Ninety two out of 100 patients had a white blood cell count (WBC) < 25 000 cells/μL at treatment start. Prophylaxis like the original venetoclax trial with allopurinol (56%), intravenous fluids (21%), and frequent lab monitoring (56%) was less common. There was a trend toward increased Cairo Bishop TLS in patients with WBC ≥ 15 000 cells/μL. In our study Howard TLS criteria better identified patients with significant TLS. Aggressive TLS prophylaxis was uncommon in our cohort and is likely unnecessary for most patients at low risk of TLS.
维奈托克联合低甲基化药物（HMA）是不符合强化化疗条件的急性髓系白血病（AML）患者的标准治疗方案，且与肿瘤溶解综合征（TLS）相关。TLS的预防以及开罗主教（Cairo Bishop）与霍华德（Howard）诊断标准的使用尚未标准化。在此，我们报告了100例连续接受维奈托克和HMA治疗的AML患者的回顾性队列中的TLS预防情况和发病率。34例患者出现实验室开罗主教TLS；其中8例符合临床开罗主教TLS标准。只有6例患者符合霍华德TLS标准。14例患者发生自发性TLS。100例患者中有92例在治疗开始时白细胞计数（WBC）<25000个细胞/μL。像最初的维奈托克试验那样使用别嘌醇（56%）、静脉输液（21%）和频繁实验室监测（56%）进行预防的情况较少见。WBC≥15000个细胞/μL的患者出现开罗主教TLS有增加的趋势。在我们的研究中，霍华德TLS标准能更好地识别出有严重TLS的患者。在我们的队列中，积极的TLS预防并不常见，而且对于大多数TLS低风险患者可能没有必要。
