Uric acid level was high

Uric ACA level was high at presentation but not at a level where nephropathy is usually expected. Yet, uric acid increased with creatinine until administration of rasburicase. Whether this increase was enough to cause or contribute to the ARF is uncertain. Comparably, Larsen and Loghman-Adham reported on two girls of eight and six years of age who were both diagnosed with ALL [7]. They presented with high uric acid values, 57.4mg/dl (3.41mmol/l) and 59.2mg/dl (3.52mmol/l), but normal kidney size. Jones et al. reported three children who presented with hyperuricemia and was diagnosed with T-ALL [8]. Table 1 summarizes previous case reports on acute renal failure as presentation of ALL. In most cases the patients needed dialysis, but no late renal complications were reported in any of the cases. The majority of cases were T-cell ALL with a white blood cell count within normal range.
Introduction Acute myeloid leukemia (AML) is a common adult leukemia, with ≈12,330 new cases reported annually in the United States [1] and ≈18,000 new cases reported annually in the European Union [2]. While AML is more common in the elderly [3], treatments for these patients are limited, especially for patients with poor performance status and/or comorbidities. The US National Comprehensive Cancer Network [3] and the European LeukemiaNet [4] recently updated their AML treatment guidelines to include low-intensity cytarabine, 5-azacytidine, and decitabine as recommended therapies for these patients. Decitabine, a hypomethylating agent, is indicated in the US for the treatment of de novo and secondary myelodysplastic syndrome of all French–American–British (FAB) subtypes and for intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System groups [5]. In Europe, decitabine is used to treat adults aged ≥65 years with newly diagnosed or secondary AML (according to World Health Organisation [WHO] classification) who are not eligible for initial treatment with standard chemotherapy [6]. A phase III trial was conducted in 485 patients aged ≥65 years with newly diagnosed AML [7]. Every 4 weeks, patients received decitabine 20mg/m2 (1-h intravenous infusion for 5 successive days) or patient′s choice of treatment, with physician′s advice, with either supportive care (SC) or cytarabine (20mg/m2 subcutaneous injection daily for 10 successive days) [7]. This post hoc analysis of this patient population examined whether baseline renal and hepatic function and white blood cell (WBC) counts are associated with response to decitabine or treatment choice.
Materials and methods For patients with available data, baseline WBC count and markers of renal function (blood urea nitrogen [BUN], creatinine, and creatinine clearance) and of hepatic function (alanine aminotransferase [ALT], aspartate aminotransferase [AST], total bilirubin, and albumin) were compared for patients with and without a response to decitabine or treatment choice. Response was defined as morphologic complete remission (CR), CR with incomplete blood count recovery (CRi), or partial remission (PR), with morphologic CR defined per the International Working Group 2003 criteria [7,8]. Comparisons between responders and nonresponders were made and P values calculated using a 2-sided t test assuming unequal group variances (significance level <0.05). Creatinine levels were also analyzed at baseline and day 1 of each cycle, stratified by response and treatment group, using a 2-sided t test assuming unequal group variances.
Results A total of 485 patients were randomized to either decitabine (n=242) or treatment choice (n=243) in the phase 3 trial [7]. At baseline, the median age of patients was 73 years (range, 64–89 years) in the decitabine group and 73 years (range, 64–91 years) in the treatment choice group. In the decitabine and treatment choice groups, respectively, median time since AML diagnosis was 14 days (range, 3–346) and 15 days (range, 0–398), and 36% and 35% of patients had secondary AML. In the decitabine group, 44% of patients had more than 50% bone marrow blasts and median white blood cell count was 3.10 (0.3–127.0) 109/L. In the treatment choice group, 42% of patients had more than 50% bone marrow blasts and median white blood cell count was 3.69 (0.5–80.9) 109/L. In each group, 36% of patients had poor-risk cytogenetics [7].