Montesinos et al developed a score for predicting the tumor lysis syndrome (TLS) in a patient with acute myeloid leukemia. The authors are from Hospital Universitario La Fe in Valencia, Spain.
Parameters:
(1) pretreatment white blood cell count
(2) serum uric acid
(3) serum LDH as multiple of the upper limit of normal (ULN)
|
Parameter |
Finding |
Points |
|
white blood cell count |
< 25,000 per µL |
0 |
|
|
25,000 to 75,000 per µL |
1 |
|
|
> 75,000 per µL |
2 |
|
uric acid |
<= 7.5 mg/dL |
0 |
|
|
> 7.5 mg/dL |
2 |
|
LDH |
<= upper limit of normal |
0 |
|
|
1.01 to 4 times ULN |
1 |
|
|
> 4 times ULN |
2 |
where:
• Table 5 assigns 1 point a uric acid > 7.5 mg/dL. However, the text states that the maximum score is 6 which cannot be achieved if 1 point is assigned. The odds ratio shown in Table 5 support assigning 2 points to an elevated uric acid concentration.
• The uric acid cutoff appears to be around the upper limit of normal.
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the chance of the tumor lysis syndrome.
|
Total Score |
Probability of Clinical TLS |
|
0 |
0% |
|
1 |
1% |
|
2 |
4% |
|
3 |
12% |
|
4 |
18% |
|
5 |
37% |
|
6 |
42% |
Performance:
• Using a cutoff of 3 had the best Youden score (sensitivity 0.89, specificity 0.80).
Specialty: Hematology Oncology, Endocrinology
