| Abstract [eng] |
Introduction. Acute leukemia is the most common oncological disease in children. Children with acute lymphoblastic leukemia may develop hyperleukocytosis (blood leukocyte count ≥100x109/l), which is associated with an increased risk of death. According to the latest guidelines, it is recommended to start full-dose chemotherapy immediately after diagnosis to reduce the tumour mass. Lysis of tumour cells releases large amounts of intracellular metabolites such as potassium, calcium, phosphorus and uric acid, and may cause kidney damage. The aim of this study was to analyse the values of metabolites of tumour cell degradation during the first 14 days after hospitalisation and to compare their dynamics between patients who received chemotherapy treatment within 48 hours of diagnosis and those who received treatment later than 48 hours. Subjects and methods. We analysed data from the first 14 days in children with acute lymphoblastic leukemia treated between 2008 and 2022 according to the NOPHO ALL2008 or ALLTogether protocols, with a peak leucocyte count at diagnosis of ≥100x109/l. Data on clinical symptoms, leukocyte counts, tumour lysis metabolites and treatment administered during the 14 days were analysed. Glomerular filtration rate was calculated to assess renal damage. Descriptive statistical analysis was used for evaluation. Results. The study included 33 patients with a median age of 5.4 years (range 1.0-15.7 years). The median maximum leukocyte count was 225.0x109/l (range 109.6-477.1x109/l). All patients received oral allopurinol on the first day and a large-volume fluid infusion with a mean volume of 3257.3 ml/m2. Chemotherapy was initiated in 20 patients (66.7%) within the first 48 hours, 13 patients (33.3%) were started from prephase. Hyperuricaemia was observed in 73.9% (N=17/23) of patients during hospitalisation. In 6/17 cases, uric acid levels were normalised solely due to the infusion of a large volume of fluids prior to chemotherapy. In the remaining 11/17 cases, hyperuricaemia peaked on the first day of chemotherapy and normalised within 1-2 days. None of the patients with normal uric acid levels at diagnosis developed hyperuricaemia later. Nine patients were hospitalised with renal impairment but did not fulfil the criteria for clinical tumorous lysis syndrome. In 7/9 patients, the glomerular filtration rate normalised after 2-4 days. Hyperphosphataemia (max. 4.8 mmol/l) occurred on the third day in 19 cases (57.6%) with a mean duration of two days. 1 patient in prephase group developed clinical tumour lysis syndrome. Conclusions. Metabolic imbalance after starting full chemotherapy within 48 hours was mild and temporary. Renal function normalised after the start of chemotherapy, regardless of the initial treatment protocol, so it is likely that the decrease in glomerular filtration rate was related to lymphoblast infiltration rather than progression of the tumour lysis syndrome. |
