RESUMEN
INTRODUCTION: Tumor lysis syndrome (TLS) occurs frequently during induction therapy for acute lymphoblastic leukemia (ALL). Patients are categorized into intermediate or high risk based on lactate dehydrogenase (LDH) value and white blood cell (WBC) count according to an expert panel, although no effort has been made to analyze TLS in ALL and its potential consequences. METHODS: We retrospectively analyzed TLS, variables associated with its occurrence and its impact in overall survival and mortality during induction in a cohort of ALL patients in their first induction regimen. RESULTS: A total of 138 patients were included. 52.9% were male and median age at diagnosis was 34 years. Most of them were treated with Hyper-CVAD (39.1%) or a modified CALGB 10403 regimen (37.7%). TLS was identified in 42 patients (30.4%), and half of them fulfilled criteria for clinical TLS (C-TLS). Median overall survival (OS) was the lowest in C-TLS patients. An LDH 3 times greater its upper normal limit (ULN) value and a WBC count equal or greater than 50â109/l were associated with TLS development, and being male, hyperuricemia and an LDH 3 times greater its ULN value were associated with C-TLS development. C-TLS and AKI were associated with excess mortality during induction. CONCLUSION: TLS was identified in almost a third of ALL patients during induction therapy. Different thresholds for LDH value and WBC count as well as other variables that could identify patients at risk to developing this complication, which is associated with shorter OS. C-TLS confers a higher risk for mortality during induction.