Abstract
Tumor lysis syndrome (TLS) and renal failure remain significant causes of morbidity and mortality in children with newly diagnosed Burkitt's lymphoma and high white blood cell count acute lymphocytic leukemia (ALL) despite conventional management with aggressive hydration, alkalinization, allopurinol, and the slow introduction of chemotherapy. A subgroup of patients at very high risk for TLS and renal failure can be identified based on the level of serum lactate dehydrogenase (LDH) and urine output. We evaluated the prospective use of continous veno-venous hemofiltration (CVVH), in addition to conventional management to prevent renal failure from tumor lysis, in three children with advanced abdominal Burkitt's lymphoma and in two children with high white blood cell count T-cel ALL who were at very high risk based on LDH and urine output. In this cohort of very highrisk patients, the LDH ratio (value at diagnosis/upper limit of normal) ranged from 0.88 to 10.3 and urine output from 0.13 to 4.7 ml/kg per hour. CVVH was begun at a mean time of 10.5 h before chemotherapy was initiated. Full-dose induction chemotherapy was begun within 24 h of diagnosis. After beginning CVVH, the uric acid levels decreased 46% prior to beginning chemotherapy and decreased to a mean of 4.2 mg/dl 24 h after chemotherapy was initiated. Four of the five patients had either no change or a drop in the serum creatinine. In patient one, blood urea nitrogen peaked at 58 mg/dl, and the creatinine at 4.7 mg/dl 6 days after beginning chemotherapy with a subsequent return to normal. Asymptomatic hypokalemia developed in all patients. After beginning chemotherapy, CVVH was continued for a mean of 85 h (range 70–91 h). No patient had complications secondary to CVVH. In summary, CVVH prevented renal failure secondary to TLS in 80% of these very high-risk patients. In the fifth patient, CVVH allowed full-dose chemotherapy to continue. The prospective use of CVVH could potentially decrease the morbidity and mortality associated with induction chemotherapy in very high-risk patients with a large tumor burden.
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References
Arrambide K, Toto RD (1993) Tumor lysis syndrome. Semin Nephrol 13:273–280
Silverman P, Distelhorst CW (1989) Metabolic emergencies in clinical oncology. Semin Oncol 16:504–515
Heney D, Essex-Cater A, Brocklebank JT, Bailey CC, Lewis IJ (1990) Continuous arteriovenous haemofiltration in the treatment of tumor lysis syndrome. Pediatr Nephrol 4:245–247
Lew SQ (1992) When to use continuous therapy: continuous arteriovenous hemofiltration or continuous veno-venous hemofiltration. Int J Artif Organs 15:633–636
Bowman WP, Shuster JC, Bhem F, Pullen J, Berard C, Murphy S (1992) Improved survival for children with B cell (sIg+) acute lymphoblastic leukemia (B-ALL) and stage IV small non-cleaved cell lymphoma (SNCCL). Proc ASCO 11:277
Griffin TC, Bowman P, Winick NJ, Buchanan GR (1994) Treatment of advanced stage diffuse, small non-cleaved cell lymphoma in childhood: further experience with total therapy B. Med Pediatr Oncol 23:393–399
Stapleton FB, Strother DR, Roy IS, Wyatt RJ, McKay CP, Murphy SB (1988) Acute renal failure at onset of therapy for advanced Burkitt lymphoma and B cell acute lymphoblastic lymphoma. Pediatrics 6:863–869
Aoki BY, McCloskey K (1992) Procedures. In: Aoki BY, McCloskey K (eds) Evaluation, stabilization and transport of the critically ill child. Mosby Year Book, St. Louis, pp 351–352
Dearth JC, Fountain KS, Smithson WA, Burgert Ed Jr., Gilcrist GS (1979) Extreme leukemic leukocytosis in childhood. Mayo Clin Proc 53:207–211
Cohen LF, Balow JE, Margrath IT, Poplack DG, Ziegler JL (1980) Acute tumor lysis syndrome. Am J Med 68:486–491
Lynch RE, Kjellstrand CM, Coccia PF (1977) Renal and metabolic complications of childhood non-Hodgkin's lymphoma. Semin Oncol 4:325–334
Monballyu J, Zachee P, Verberckmoes R, Boogaerts MA (1984) Transient acute renal failure due to tumor lysis induced severe phosphate load in a patient with Burkitt's lymphoma. Clin Nephrol 22:47–50
Cadman EC, Lundberg WB, Bertino JR (1977) Hyperphosphatemia and hypocalcemia accompanying rapid cell lysis in a patient with Burkitt's lymphoma and Burkitt cell leukemia. Am J Med 62:283–290
Band PR, Silverberg DS, Verberckmoes R (1970) Transient acute renal failure due to tumor lysis induced severe phosphate load in a patient treated with allopurinol. N Engl J Med 7:354–357
Kramer P, Wigger W, Rieger J, Matthali D, Scheler F (1977) Arteriovenous hemofiltration: a new and simple method for the treatment of overhydrated patients resistant to diuretics. Klin Wochensch 55:1121–1122
Heney D, Brocklebank JT, Wilson N (1989) Continuous arteriovenous haemofiltration in the newly born with acute renal failure and congenital heart disease. Nephrol Dial Transplant 4:870–876
Lieberman KV (1987) Continuous arteriovenous hemofiltration in children. Pediatr Nephrol 1:330–338
Geroneumus R, Schneider N (1984) Continuous arteriovenous hemodialysis: a new modality for treatment of acute renal failure. Trans Am Soc Artif Organs 30:610–613
Bishof NA, Welch TR, Strife CF, Rychman FC (1990) Continuous hemodiafiltration in children. Pediatrics 85:819–823
Magrath I (1993) Malignant non-Hodgkin's lymphomas in children. In: Pizzo PA, Poplack DG (eds) Principles and practice of pediatric oncology. Lippincott, Philadelphia, pp 537–575
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Saccente, S.L., Kohaut, E.C. & Berkow, R.L. Prevention of tumor lysis syndrome using continuous veno-venous hemofiltration. Pediatr Nephrol 9, 569–573 (1995). https://doi.org/10.1007/BF00860936
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DOI: https://doi.org/10.1007/BF00860936