SHM's Clinical Quick Talks-Approach to Tumor Lysis Syndrome in Adults

Pdf Summary

Tumor Lysis Syndrome (TLS) is a potentially severe condition that results from the rapid breakdown of cancer cells, releasing large amounts of intracellular contents into the bloodstream. This can occur spontaneously or be induced by cancer treatment, primarily affecting patients with hematological malignancies, such as non-Hodgkin’s lymphoma, Burkitt’s lymphoma, acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML). Symptoms can arise within 12–72 hours post-treatment or even spontaneously, especially in those with preexisting conditions like renal disease or dehydration.<br /><br />TLS is characterized by laboratory abnormalities including hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia. The clinical manifestation requires these lab criteria plus at least one of renal insufficiency, seizure, cardiac arrhythmia, or sudden death.<br /><br />Monitoring for TLS involves frequent laboratory assessments after chemotherapy initiation. Prevention strategies revolve around risk stratification, classifying patients into low, intermediate, or high-risk categories based on factors like tumor type and white blood cell count. <br /><br />Prevention and treatment include hydration to enhance excretion of uric acid and phosphate and the use of medications such as allopurinol, which inhibits uric acid production, and rasburicase, which rapidly reduces uric acid levels. For electrolyte imbalances, phosphate binders and potassium-lowering agents might be necessary, with hemodialysis as a last resort for severe cases. Symptomatic hypocalcemia is managed cautiously to avoid calcium-phosphate precipitation.<br /><br />Key to managing TLS is early prevention and treatment planning for high-risk patients starting therapy, being aware it can also occur before or after treatment, or in cancers previously considered low risk, given the potency of treatment options.

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Ted Raddell, Sameena Khan

Keywords

Tumor Lysis Syndrome

TLS

cancer treatment

hematological malignancies

hyperkalemia

hyperuricemia

risk stratification

allopurinol

rasburicase

electrolyte imbalances