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Acute Lymphoblastic Leukemia

Urolithiasis in pediatric patients with acute lymphoblastic leukemia

Leukemia volume 17, pages 541–546 (2003)Cite this article

Abstract

We evaluated the incidence, timing, and consequences of urolithiasis in children with acute lymphoblastic leukemia (ALL). A total of 20 patients with urolithiasis were identified from 2095 patients with ALL treated at St Jude Children's Research Hospital on consecutive protocols between 1968 and 1998. For remission induction therapy, all patients received daily prednisone; continuation chemotherapy regimens differed by protocol with some including pulses of prednisone or dexamethasone and others no glucocorticoid. Patients with urolithiasis were older at diagnosis of ALL than those without urolithiasis (median age, 7.5 vs 5.0 years; P=0.03) and less likely to be black (P=0.03) than white or Hispanic, but sex and treatment era did not differ. Presenting symptoms included abdominal or flank pain, hematuria, and dysuria. All stones analyzed biochemically were calcium stones. The incidence of urolithiasis after completion of therapy was 1.8 per 10 000 person-years. Compared to this baseline rate, the relative risk of urolithiasis was 45 (P<0.01) during induction therapy, 22 (P<0.01) during continuation therapy with glucocorticoids, and 5.1 (P>0.05) during continuation therapy without glucocorticoids. Urolithiasis occurred 4.5 times more often during continuation treatment with glucocorticoids than without (P<0.05). Seven patients (35%) had recurrent urolithiasis. Patients with ALL are at risk of developing calcium renal stones during chemotherapy, especially when a glucocorticoid is included.

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Authors and Affiliations

  1. Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    S C Howard, B I Razzouk, G K Rivera, J T Sandlund, R C Ribeiro, J E Rubnitz, A J Gajjar, M Hudson & C-H Pui

  2. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    S C Howard, S D Kaplan, B I Razzouk, G K Rivera, J T Sandlund, R C Ribeiro, J E Rubnitz, A J Gajjar, S Roy III, M Hudson & C-H Pui

  3. Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA

    W Ke, M L Hancock & J P Skoch

  4. Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA

    C-H Pui

Authors
  1. S C Howard
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  2. S D Kaplan
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  3. B I Razzouk
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  4. G K Rivera
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  6. R C Ribeiro
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  7. J E Rubnitz
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  8. A J Gajjar
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  9. W Ke
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  10. M L Hancock
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  11. J P Skoch
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  12. S Roy III
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  13. M Hudson
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  14. C-H Pui
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Additional information

Supported in part by Cancer Center Support (CORE) Grant CA-21765 from the National Cancer Institute, by a Center of Excellence grant from the state of Tennessee, and by the American Lebanese Syrian Associated Charities (ALSAC). C-H Pui is the American Cancer Society-FM Kirby Clinical Research Professor.

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Howard, S., Kaplan, S., Razzouk, B. et al. Urolithiasis in pediatric patients with acute lymphoblastic leukemia. Leukemia 17, 541–546 (2003). https://doi.org/10.1038/sj.leu.2402852

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