Urolithiasis in Children with Acute Lymphoblastic Leukemia
Keywords:Urothelial carcinoma, cisplatin, gemcitabine, pathological complete response.
Background: Urinary tract lithiasis(UTL) requires careful intervention, especially when associated with other diseases. The purpose of this study was to assess the outcome of symptomatic UTL in children with acute lymphoblastic leukemia (ALL) and to evaluate its correlation with the anti-neoplastic treatment phase and drugs, and to assess the need for intervention, results, complications and follow-up.
Procedure: The charts of 350 patients with ALL (1990-2008) were retrospectively evaluated. Signs and symptoms, methods of diagnosis, complications, treatment approach, resolution, anti-leukemic treatment phase when the UTL was diagnosed, drugs used and interference on ALL treatment were recorded.
Results: A total of 12/350 patients (3.4%) had UTL (14 stones). The median age was 7.6 years. Pain was present in 60%, hematuria in 20% and both in 20%. The median stone size was 4mm (3- 13.8mm). Three patients required hospitalization (pain) and one had chemotherapy discontinued due to severe hematuria and blood support. At the time of diagnosis of UTL, four patients were in the induction phase with corticosteroids, four were in the maintenance phase with corticosteroids, two were in the maintenance phase without corticosteroids, and one had a recurrence after therapy, and two were off-therapy. 11/13 episodes of UTL had spontaneous resolution, two underwent successful extracorporeal shockwave lithotripsy, and one patient remains with an asymptomatic stone.
Conclusions: 3.4% of children with ALL presented symptomatic UTL. While the majority of cases have been resolved spontaneously, hospitalization and delay in chemotherapy have increased morbidity in these children.
Pui CH, Evans WE. Acute lymphoblastic leukemia. N Engl J Med 1998; 339: 605-15. http://dx.doi.org/10.1056/NEJM199808273390907
Fogliatto L, Bittencourt H, Nunes AS, et al. Outcome of treatment in adult acute lymphoblastic leukemia in southern Brazil using a modified German multicenter acute lymphoblastic leukemia protocol. Acta Haematol 2002; 107: 203-7. http://dx.doi.org/10.1159/000058315
Câncer da criança e adolescente no Brasil: dados dos registros de base populacional e de mortalidade. Instituto Nacional do Câncer 2008; 64.
Langebrake C, Reinhardt D, Ritter J. Minimazing the long-term adverse effects of childhood leukaemia therapy. Drug Saf 2002; 25: 1057-77. http://dx.doi.org/10.2165/00002018-200225150-00002
Möricke A, Reiter A, Zimmermann M, Gadner H, Stanulla M, Dördelmann M, et al. Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood 2008; 111: 4477-89. http://dx.doi.org/10.1182/blood-2007-09-112920
Silverman LB, Gelber RD, Dalton VK, Asselin BR, Barr RD, Clavell LA, et al. Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol-91. Blood 2001; 97: 1211-8. http://dx.doi.org/10.1182/blood.V97.5.1211
Trigg ME, Sather HN, Reaman GH, Tubergen DG, Steinherz PG, Gaynon PS, et al. Ten-year survival of children with acute lymphoblastic leukemia: a report from the Children’s Oncology Group. Leuk and Lymphoma 2008; 49: 1142-54. http://dx.doi.org/10.1080/10428190802074593
Haddy TB, Mosher RB, Reaman GH. Osteoporosis in survivors of acute lymphoblastic leukemia. Oncologist 2001; 6: 278-85. http://dx.doi.org/10.1634/theoncologist.6-3-278
Kaste SC, Rai SN, Fleming K, McCammon EA, Tylavsky FA, Danish RK, et al. Bone mineral decrements in survivors of childhood acute lymphoblastic leukemia: frequency of occurrence and risk factors for their development. Leukemia 2001; 15: 728-34. http://dx.doi.org/10.1038/sj.leu.2402078
Gillespie RS, Stapleton FB. Nephrolithiasis in children. Pediatr Rev 2004; 25: 131-9. http://dx.doi.org/10.1542/pir.25-4-131
Bleyer A, Agus ZS. Approach to nephrolithiasis. Kidney 1992; 25: 1-10.
Polinsky MS, Kaiser BA, Baluarte HJ. Urolithiasis in childhood. Pediatr Clin North Am 1987; 34: 683-10.
Pui CH, Roy 3rd S, Noe HN. Urolithiasis in childhood acute leukemia and nonHodgkin's lymphoma. J Urol 1986; 136: 1052-4.
Howard SC, Howard SC, Kaplan SD, Razzouk BI, Rivera GK, Sandlund JT, et al. Urolithiasis in pediatric patients with acute lymphoblastic leukemia. Leukemia 2003; 17: 541-6. http://dx.doi.org/10.1038/sj.leu.2402852
Kaste SC, Thomas NA, Rai SN, Cheon K, McCammon E, Chesney R, et al. Asymptomatic kidney stones in long-term survivors of childhood acute lymphoblastic leukemia. Leukemia 2009; 23: 104-8. http://dx.doi.org/10.1038/leu.2008.269
Bush NC, Xu L, Brown BJ, Holzer MS, Gingrich A, Schuler B, et al. Hospitalizations for pediatric stone disease in United States, 2002-2007. J Urol 2010; 183: 1151-6. http://dx.doi.org/10.1016/j.juro.2009.11.057
Elder JS. Urinary lithiasis, in Nelson textbook of pediatrics, Behrman ER, Kliegman MR, Jenson BH, Eds. Saunders: Philadelphia 2000; pp. 1655-1658.
Duarte RJ, Mitre AI, Dénes FT, et al., Extracorporeal lithotripsy for the treatment of urolithiasis in childre
Walther PC, Lamm D, Kaplan GW. Pediatric urolithiases: a ten-year review. Pediatrics 1980; 65: 1068-72.
Troup CW, Lawnicki CC, Bourne RB, Hodgson NB. Renal calculus in children. J Urol 1972; 107: 306-7.
Nimkin K, Lebowitz RL, Share JC, Teele RL. Urolithiasis in a children's hospital: 1985-1990. Urol Radiol 1992; 14: 139-43. http://dx.doi.org/10.1007/BF02926915
Polito C, La Manna A, Signoriello G, Marte A. Recurrent abdominal pain in childhood urolithiasis. Pediatrics 2009; 124: 1088-94. http://dx.doi.org/10.1542/peds.2009-0825
Hesse A, Brändle E, Wilbert D, et al. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol 2003; 44: 709-13. http://dx.doi.org/10.1016/S0302-2838(03)00415-9
Weisberger AS, Persky L. Renal calculi and uremia as complications of lymphoma. Am J Med Sci 1953; 225: 669-73. http://dx.doi.org/10.1097/00000441-195306000-00012
van der Veen MJ, Bijlsma JW. Effects of different regimens of corticosteroid treatment on calcium and bone metabolism in rheumatoid arthritis. Clin Rheumatol 1992; 11: 388-92. http://dx.doi.org/10.1007/BF02207199
Geusens PP, de Nijs RN, Lems WF, Laan RF, Struijs A, van Staa TP, et al. Prevention of glucocorticoid osteoporosis: a consensus document of the Dutch Society for Rheumatology. Ann Rheum Dis 2004; 63: 324-5. http://dx.doi.org/10.1136/ard.2003.008060
Bijlsma JW. Supplementation of vitamin D plus calcium is effective in corticosteroid-induced osteoporosis management. Clin Exp Rheumatol 2000; 18: 3-4.
Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc 1993; 68: 241-8. http://dx.doi.org/10.1016/S0025-6196(12)60043-3
Hiorns MP. Imaging of urinary tract lithiasis: who, when and how? Pediatr Radiol 2008; 38: 497-500. http://dx.doi.org/10.1007/s00247-008-0847-4
Hesse A, Straub M. Rational evaluation of urinary stone disease. Urol Res 2006; 34: 126-30. http://dx.doi.org/10.1007/s00240-005-0024-2