혈액종양환자에서 종양용해증후군 위험 분류에 따른 예방적 약물 사용
Use of Prophylactic Drugs according to Risk Classification for TLS in Patients with Hematological Malignancies
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Background : Tumor lysis syndrome (TLS) is a metabolic syndrome caused by the release of intracellular uric acid, potassium, and phosphorus into the blood due to sudden tumor necrosis. If inadequate prophylactic therapy for TLS or treatment is delayed, complication risks may increase. Therefore, it is important to identify patients at high risk of TLS before chemotherapy. In this study, appropriate prophylactic drug use for TLS risk groups was investigated, and its association with TLS occurrence was analyzed. Methods : From January 2019 to December 2021, electronic medical records of adult hematologic oncology patients aged ≥19 years who were hospitalized for their first chemotherapy for hematological tumors were retrospectively analyzed. Diagnosis, hematological and laboratory values, and administration information of allopurinol and rasburicase were collected. TLS risk was evaluated according to the 2010 TLS management recommendation by Cairo et al. Appropriate prophylactic drug use and the TLS occurrence were analyzed. Results : Of 561 patients, 366 (65.2%), 159 (28.3%), and 36 (6.4%) were in low-risk, moderate- risk, and high-risk groups, respectively, by TLS risk classification. A total of 138 (24.6%), 420 (74.9%), and three (0.5%) patients received undertreatment, proper treatment, and overtreatment in TLS prophylaxis, respectively. Multiple logistic regression analysis showed that TLS risk was higher in the high-risk group than in the low-risk group (adjusted OR: 17.14, 95% CI: 5.56-52.87). In terms of the adequacy of TLS prophylaxis, the TLS incidence was the highest in those with under-prophylaxis, although the difference was not statistically significant. Conclusion : Classifying the high-risk group before chemotherapy in hematological malignancies patients is a major predictor of future TLS development. In under-prophylaxis cases, the TLS incidence tended to increase, especially in high-risk groups. Therefore, the decisions of TLS prophylactic drug should be appropriately implemented and monitored before chemotherapy.
Abstract
Background : Tumor lysis syndrome (TLS) is a metabolic syndrome caused by the release of intracellular uric acid, potassium, and phosphorus into the blood due to sudden tumor necrosis. If inadequate prophylactic therapy for TLS or treatment is delayed, complication risks may increase. Therefore, it is important to identify patients at high risk of TLS before chemotherapy. In this study, appropriate prophylactic drug use for TLS risk groups was investigated, and its association with TLS occurrence was analyzed. Methods : From January 2019 to December 2021, electronic medical records of adult hematologic oncology patients aged ≥19 years who were hospitalized for their first chemotherapy for hematological tumors were retrospectively analyzed. Diagnosis, hematological and laboratory values, and administration information of allopurinol and rasburicase were collected. TLS risk was evaluated according to the 2010 TLS management recommendation by Cairo et al. Appropriate prophylactic drug use and the TLS occurrence were analyzed. Results : Of 561 patients, 366 (65.2%), 159 (28.3%), and 36 (6.4%) were in low-risk, moderate- risk, and high-risk groups, respectively, by TLS risk classification. A total of 138 (24.6%), 420 (74.9%), and three (0.5%) patients received undertreatment, proper treatment, and overtreatment in TLS prophylaxis, respectively. Multiple logistic regression analysis showed that TLS risk was higher in the high-risk group than in the low-risk group (adjusted OR: 17.14, 95% CI: 5.56-52.87). In terms of the adequacy of TLS prophylaxis, the TLS incidence was the highest in those with under-prophylaxis, although the difference was not statistically significant. Conclusion : Classifying the high-risk group before chemotherapy in hematological malignancies patients is a major predictor of future TLS development. In under-prophylaxis cases, the TLS incidence tended to increase, especially in high-risk groups. Therefore, the decisions of TLS prophylactic drug should be appropriately implemented and monitored before chemotherapy.
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