ĐẶC ĐIỂM HỘI CHỨNG LY GIẢI U Ở TRẺ BỆNH ÁC TÍNH ĐIỀU TRỊ TẠI BỆNH VIỆN NHI ĐỒNG 2

Abstract

Background and aims: Tumor lysis syndrome (TLS) is a life-threatening oncological emergency that can lead to arrhythmias, seizures, kidney failure and death without appropriate prophylaxis and treatment. This study aims to evaluate the clinical, laboratory, diagnosis and treatment features related to severe tumor lysis syndrome in newly diagnosed cancer children treated in Children Hospital 2 (CH2), Vietnam. Methods: We performed an observational study of newly confirmed diagnosed malignancies treated at CH2 from October 2021 to May 2022. TLS was defined as Cairo-Bishop criteria [5]. Information from medical records of diagnosis, clinical, laboratory and treatment details of the first chemotherapy course were input into Epidata, analyzed with STATA version 14. Results: Among 174 patients, the mean age was 76,9 ± 53,6 months with sex ratio 1,32/1. There were 35/174 cases (20,1%) diagnosed with TLS, of which 17 cases (48.6%) occurred spontaneously before chemotherapy. In our study, TLS was most common in acute lymphoblastic leukemia with more than 2/3 of cases, followed by non-Hodgkin lymphoma (17.2%). In 157 patients without TLS at the time of diagnosis, 75 cases (47,8%) received prophylaxis with hyperhydration and allopurinol from admission, of which 17/75 patients (22,7%) progressed to TLS. They were treated with hyperhydration, allopurinol, electrolytes adjustment and close monitoring. One case required dialysis six times and subsequently died due to sepsis shock. Conclusions: In our study, the incidence of TLS pediatric malignancies was 20,1%. TLS occurred mainly in children with acute lymphoblastic leukemia and non-Hodgkin lymphoma. Because of limited access to advanced treatments, such as rasburicase, early risk stratification and appropriate prevention in high-risk children are particularly important in the management of TLS.