What severe condition should be monitored in children receiving chemotherapy for ALL?

In children undergoing chemotherapy for acute lymphoblastic leukemia (ALL), tumor lysis syndrome (TLS) is a serious condition that requires close monitoring. TLS occurs when large numbers of cancer cells are killed off rapidly, releasing their contents into the bloodstream. This can lead to metabolic imbalances, including hyperuricemia (high levels of uric acid), hyperkalemia (high levels of potassium), hyperphosphatemia (high levels of phosphate), and hypocalcemia (low levels of calcium). These imbalances can lead to severe complications such as acute kidney injury and cardiac arrhythmias.

Because chemotherapy often leads to a rapid cell turnover, the risk of developing TLS is especially high during the initial stages of treatment, particularly for leukemias and aggressive lymphomas. Therefore, it is crucial for healthcare providers to monitor for signs of TLS, such as changes in renal function, electrolyte levels, and symptoms related to the metabolic disturbances that can occur.

Other conditions mentioned, while important to monitor in the context of chemotherapy, do not present the same level of acute risk associated with rapid treatment changes: hemolytic anemia is a possible side effect, fever indicates potential infection risk, and dehydration from side effects like vomiting may occur but is generally more manageable compared