Journal
LEUKEMIA
Volume 25, Issue 9, Pages 1444-1451Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/leu.2011.109
Keywords
chronic lymphocytic leukemia; flavopiridol; tumor lysis syndrome
Categories
Funding
- NCI [K23 CA109004-01A1, K12 CA133250, U01 CA076576, NO1 CM62207]
- Leukemia and Lymphoma Society [SCOR 7080-06]
- D Warren Brown Foundation
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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), beta 2-microglobulin, and lactate dehydrogenase were associated (P<0.05) with TLS. In multivariable analysis, female gender, adenopathy >= 10 cm, elevated WBC, increased beta 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 b2-microglobulin, increased WBC, adenopathy >= 10cm 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 (2011) 25, 1444-1451; doi: 10.1038/leu.2011.109; published online 24 May 2011
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