Risk factors for tumor lysis syndrome in patients with chronic lymphocytic leukemia treated with the cyclin-dependent kinase inhibitor, flavopiridol.
Risk factors for tumor lysis syndrome in patients with chronic lymphocytic leukemia treated with the cyclin-dependent kinase inhibitor, flavopiridol.
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作者：
在接受细胞周期蛋白依赖性激酶抑制剂flavopiridol治疗的慢性淋巴细胞白血病（CLL）患者中，超过40%的患者出现肿瘤溶解综合征（TLS）。我们进行了回顾性分析，以确定TLS的预测因素。在116例患者中，TLS的发生率为46%（95% CI：36%-55%）。在单变量分析中，女性、既往治疗次数较多、Rai III-IV期、淋巴结肿大≥ 10 cm、脾肿大、del（11 q）、白蛋白降低、淋巴细胞绝对计数、白色细胞计数（WBC）、β2-微球蛋白和乳酸脱氢酶（LDH）升高与TLS相关（p<0.05）。在多因素分析中，女性、腺病≥ 10 cm、WBC升高、β2-微球蛋白升高和白蛋白降低与TLS相关（p<0.05）。关于患者结局，分别有49%和44%的TLS患者对flavopiridol有反应（p=0.71）。在控制既往治疗次数、细胞遗传学、Rai分期、年龄和性别的多变量分析中，TLS患者的无进展生存期（PFS）较差（p=0.01）。女性患者和β2-微球蛋白升高、WBC升高、腺病≥ 10 cm和白蛋白降低的患者风险最高，应使用flavopiridol监测TLS。TLS似乎不能预测接受flavopiridol的患者的缓解或PFS改善。
Tumor lysis syndrome (TLS) has been described in over 40% of patients with chronic lymphocytic leukemia (CLL) treated with the cyclin dependent kinase inhibitor, flavopiridol. We conducted a retrospective analysis to determine predictive factors for TLS. In 116 patients, the incidence of TLS was 46% (95% CI: 36%-55%). In univariable analysis, female gender, greater number of prior therapies, Rai stages III-IV, adenopathy ≥ 10 cm, splenomegaly, del(11q), decreased albumin, and increased absolute lymphocyte count, white blood cell count (WBC), β2-microglobulin, and lactate dehydrogenase (LDH) were associated (p<0.05) with TLS. In multivariable analysis, female gender, adenopathy ≥ 10 cm, elevated WBC, increased β2-microglobulin, and decreased albumin were associated with TLS (p<0.05). With respect to patient outcomes, 49% and 44% of patients with and without TLS, respectively, responded to flavopiridol (p=0.71). In a multivariable analysis controlling for number of prior therapies, cytogenetics, Rai stage, age, and gender, progression-free survival (PFS) was inferior in patients with TLS (p=0.01). Female patients and patients with elevated β2-microglobulin, increased WBC, adenopathy ≥ 10 cm, and decreased albumin were at highest risk and should be monitored for TLS with flavopiridol. TLS does not appear to be predictive of response or improved PFS in patients receiving flavopiridol.
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DOI：
10.3324/haematol.13290
发表时间：
2008-12-01
期刊：
HAEMATOLOGICA-THE HEMATOLOGY JOURNAL
影响因子：
--
作者：
Tosi, Patrizia;Barosi, Giovanni;Tura, Sante
通讯作者：
Tura, Sante
影响因子：
20.3
作者：
Byrd, John C.;Lin, Thomas S.;Grever, Michael R.
通讯作者：
Grever, Michael R.
影响因子：
45.3
作者：
Lin, Thomas S.;Ruppert, Amy S.;Byrd, John C.
通讯作者：
Byrd, John C.
影响因子：
6.5
作者：
Cairo, Mitchell S.;Coiffier, Bertrand;Younes, Anas
通讯作者：
Younes, Anas
影响因子：
45.3
作者：
O'Brien, Susan;Moore, Joseph O.;Rai, Kanti R.
通讯作者：
Rai, Kanti R.