Mato AR et al. (2006) A predictive model for the detection of tumor lysis syndrome during AML induction therapy. Leuk Lymphoma doi: 10.1080/10428190500404662]

Researchers from the USA have developed the first predictive model for TUMOR LYSIS SYNDROME (TLS) in patients undergoing induction chemotherapy for acute myelogenous leukemia (AML) or myelodysplastic syndrome. The Penn Predictive Score of Tumor Lysis Syndrome (PPS-TLS) was designed as part of a retrospective cohort study of 194 patients treated for AML or myelodysplastic syndrome at the Hospital of the University of Pennsylvania.

Patients received one of a range of induction chemotherapy regimens in combination with standard TLS prophylaxis. Blood chemistry analysis was carried out frequently both prior to chemotherapy and during the week following completion of treatment. TLS was defined as either a doubling of baseline creatinine with elevation of phosphate, uric acid or potassium, or stable creatinine with an increase in the level of two of these electrolytes. TLS developed in 19 (9.8%) patients, 6 with doubling creatinine and 13 with stable creatinine. Univariate analysis revealed the following six prognostic indicators of TLS: elevated baseline creatinine, uric acid, lactate dehydrogenase or white blood cell count; male sex; and history of chronic myelomonocytic leukemia. In the multivariate analysis, three factors remained significant predictors of TLS: lactate dehydrogenase (P = 0.0042), uric acid (P = 0.0001), and male sex (P = 0.0073). The PPS-TLS model was devised using these three prognostic indicators, with cumulative scores ranging from 0–10 indicating increasing risk of TLS.

The authors conclude that this work could lay the foundation upon which evidence-based guidelines for monitoring TLS in this patient population could be based.