Urolithiasis in pediatric patients with acute lymphoblastic leukemia

Scott Howard, S. D. Kaplan, B. I. Razzouk, G. K. Rivera, J. T. Sandlund, R. C. Ribeiro, J. E. Rubnitz, A. J. Gajjar, W. Ke, M. L. Hancock, J. P. Skoch, S. Roy, M. Hudson, C. H. Pui

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Abstract

We evaluated the incidence, timing, and consequences of urolithiasis in children with acute lymphoblastic leukemia (ALL). A total of 20 patients with urolithiasis were identified from 2095 patients with ALL treated at St Jude Children's Research Hospital on consecutive protocols between 1968 and 1998. For remission induction therapy, all patients received daily prednisone; continuation chemotherapy regimens differed by protocol with some including pulses of prednisone or dexamethasone and others no glucocorticoid. Patients with urolithiasis were older at diagnosis of ALL than those without urolithiasis (median age, 7.5 vs 5.0 years; P = 0.03) and less likely to be black (P = 0.03) than white or Hispanic, but sex and treatment era did not differ. Presenting symptoms included abdominal or flank pain, hematuria, and dysuria. All stones analyzed biochemically were calcium stones. The incidence of urolithiasis after completion of therapy was 1.8 per 10 000 person-years. Compared to this baseline rate, the relative risk of urolithiasis was 45 (P<0.01) during induction therapy, 22 (P<0.01) during continuation therapy with glucocorticoids, and 5.1 (P>0.05) during continuation therapy without glucocorticoids. Urolithiasis occurred 4.5 times more often during continuation treatment with glucocorticoids than without (P<0.05). Seven patients (35%) had recurrent urolithiasis. Patients with ALL are at risk of developing calcium renal stones during chemotherapy, especially when a glucocorticoid is included.

Original languageEnglish (US)
Pages (from-to)541-546
Number of pages6
JournalLeukemia
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2003

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Urolithiasis
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Glucocorticoids
Prednisone
Calcium
Flank Pain
Therapeutics
Remission Induction
Dysuria
Drug Therapy
Incidence
Hematuria
Hispanic Americans
Abdominal Pain
Dexamethasone
Kidney
Research

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Howard, S., Kaplan, S. D., Razzouk, B. I., Rivera, G. K., Sandlund, J. T., Ribeiro, R. C., ... Pui, C. H. (2003). Urolithiasis in pediatric patients with acute lymphoblastic leukemia. Leukemia, 17(3), 541-546. https://doi.org/10.1038/sj.leu.2402852

Urolithiasis in pediatric patients with acute lymphoblastic leukemia. / Howard, Scott; Kaplan, S. D.; Razzouk, B. I.; Rivera, G. K.; Sandlund, J. T.; Ribeiro, R. C.; Rubnitz, J. E.; Gajjar, A. J.; Ke, W.; Hancock, M. L.; Skoch, J. P.; Roy, S.; Hudson, M.; Pui, C. H.

In: Leukemia, Vol. 17, No. 3, 01.03.2003, p. 541-546.

Research output: Contribution to journalArticle

Howard, S, Kaplan, SD, Razzouk, BI, Rivera, GK, Sandlund, JT, Ribeiro, RC, Rubnitz, JE, Gajjar, AJ, Ke, W, Hancock, ML, Skoch, JP, Roy, S, Hudson, M & Pui, CH 2003, 'Urolithiasis in pediatric patients with acute lymphoblastic leukemia', Leukemia, vol. 17, no. 3, pp. 541-546. https://doi.org/10.1038/sj.leu.2402852
Howard S, Kaplan SD, Razzouk BI, Rivera GK, Sandlund JT, Ribeiro RC et al. Urolithiasis in pediatric patients with acute lymphoblastic leukemia. Leukemia. 2003 Mar 1;17(3):541-546. https://doi.org/10.1038/sj.leu.2402852
Howard, Scott ; Kaplan, S. D. ; Razzouk, B. I. ; Rivera, G. K. ; Sandlund, J. T. ; Ribeiro, R. C. ; Rubnitz, J. E. ; Gajjar, A. J. ; Ke, W. ; Hancock, M. L. ; Skoch, J. P. ; Roy, S. ; Hudson, M. ; Pui, C. H. / Urolithiasis in pediatric patients with acute lymphoblastic leukemia. In: Leukemia. 2003 ; Vol. 17, No. 3. pp. 541-546.
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