هیپراوریسمی در کودکان مبتلا به لنفوم و لوسمی و نقش درمان پروفیلاکتیک

Background: Hyperuricemia is one of the oncologic emergency that occurs most often in patients with hematologic disorders particularly leukemia and high-grade lymphoma. This study was conducted in order to determine the prevalence of hyperuricemia with respect to prophylactic treatment (in particular allopurinol) in patients with lymphoproliferative disease in the pediatric hematologic ward of Imam Khomeini Hospital, Tehran. Methods: In this retrospective cross-sectional study, 316 children (75 females, 241 males) under the age of 12 years participated. Among the subjects, 66 patients (20.9%) had lymphoma and 250 patients (79.1%) had leukemia.Results: Of the 56 (17.7%) patients diagnosed with hyperuricemia, 13 with lymphoma (19.7%) and 43 (17.2%) with acute lymphoblastic leukemia, 52 patients showed hyperuricemia after induction of chemotherapy (p<0.001). Hyperuricemia was more prevalent in patients with more advanced disease (50.9% in stage IV, p<0.001). Hyperuricemia was more frequent in male patients (p<0.001). Among the 217 patients who had received prophylaxis (hydration, alkalization, allopurinol), 19 (8.7%) subjects had hyperuricemia compare to 37.3% in the group of patients who did not receive prophylactic treatment (p<0.001). Conclusion: From the literature reviewed, a recombinant form of the urate oxidase enzyme (rasburicase) is a safe and effective alternative to allopurinol to rapidly control plasma uric acid concentrations in patients with hematologic malignancy at high risk for tumor lysis during induction of chemotherapy. In this respect, we recommend a prospective study to compare allopurinol and rasburicase in children with leukemia and lymphoma.