Risk factors for tumor lysis syndrome in patients with chronic lymphocytic leukemia treated with the cyclin-dependent kinase inhibitor, flavopiridol

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BlankRisk factors for tumor lysis syndrome in patients with chronic lymphocytic

leukemia treated with the cyclin-dependent kinase inhibitor, flavopiridol.

KA Blum, AS Ruppert, JA Woyach, JA , L Andritsos, JM Flynn, B Rovin, M

Villalona-Calero, J Ji, M Phelps, AJ , MR Grever, and JC Byrd

Leukemia, May 24, 2011; .

Division of Hematology, Department of Internal Medicine, The Arthur G.

Comprehensive Cancer Center and The Ohio State University, Columbus, OH, USA.

Tumor lysis syndrome (TLS) has been described in over 40% of patients with

chronic lymphocytic leukemia 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),

?2-microglobulin, and lactate dehydrogenase were associated (P<0.05) with TLS.

In multivariable analysis, female gender, adenopathy ?10?cm, elevated WBC,

increased ?2-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

?2-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.Leukemia advance online publication, 24 May 2011;

doi:10.1038/leu.2011.109.

PMID: 21606960