From the Guidelines
Risk of Tumor Lysis Syndrome in Lymphoma
The risk of tumor lysis syndrome (TLS) is high in certain lymphoma subtypes, particularly those with a high proliferative rate and sensitivity to chemotherapy, such as Burkitt lymphoma and lymphoblastic lymphoma 1.
Factors Influencing TLS Risk
Several factors contribute to the risk of developing TLS, including:
- Tumor burden, reflected by serum lactate dehydrogenase (LDH) levels, white blood cell count, extensive bone marrow involvement, and tumor size 1
- Comorbidities, such as elevated pre-treatment serum uric acid levels, pre-existing renal damage, tumor infiltration in the kidney, obstructive uropathy, and advanced age 1
- Cytotoxic therapies, especially those employing highly active, cycle-specific drugs like cytosine arabinoside, etoposide, and cisplatin 1
Prophylactic Measures
To mitigate the risk of TLS, prophylactic measures are recommended, including:
- Hydration with at least 2-3 liters of intravenous fluids per day 1
- Rasburicase 0.1-0.2 mg/kg or allopurinol 300 mg per day, starting 24 hours before initiation of chemotherapy 1
- Close monitoring of electrolytes, renal function, and uric acid levels 1
High-Risk Patients
Patients with high-risk lymphoma subtypes should receive prophylactic measures, and those with a high risk of developing TLS should be closely monitored for signs of the syndrome 1.
Management of TLS
Management of TLS involves addressing hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, and may require renal dialysis in severe cases 1.
In summary, the risk of tumor lysis syndrome is significant in certain lymphoma subtypes, and prophylactic measures, including hydration, rasburicase or allopurinol, and close monitoring, are essential to prevent and manage this potentially life-threatening complication 1.
From the FDA Drug Label
Tumor Lysis Syndrome (TLS) Clinical TLS was defined by changes in at least two or more laboratory parameters for hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia and at least one of the following events occurring within 7 days of treatment: renal failure/injury, need for renal dialysis, and/or serum creatinine increase >1.5 ULN, arrhythmia or seizure. Clinical TLS occurred in 3% of Elitek-treated patients, 3% of Elitek/allopurinol-treated patients, and 4% of allopurinol-treated patients.
The risk of tumor lysis syndrome in lymphoma is 3% in patients treated with rasburicase (Elitek) and 4% in patients treated with allopurinol, as reported in a study of 275 adult patients with leukemia, lymphoma, or solid tumor malignancies at risk for hyperuricemia and TLS 2.
- Key points:
- Clinical TLS definition: changes in at least two laboratory parameters and at least one event (renal failure, dialysis, serum creatinine increase, arrhythmia, or seizure) within 7 days of treatment
- Incidence of clinical TLS: 3% in Elitek-treated patients, 3% in Elitek/allopurinol-treated patients, and 4% in allopurinol-treated patients
From the Research
Risk of Tumor Lysis Syndrome in Lymphoma
- The risk of tumor lysis syndrome is enhanced in Burkitt's lymphoma due to its high proliferation rate, as large numbers of malignant cells are lysed during cytotoxic chemotherapy 3.
- Tumor lysis syndrome is a potentially fatal complication that occurs spontaneously or upon initiation of chemotherapy in Burkitt's lymphoma 4.
- Prompt recognition and initiation of comprehensive supportive care are essential for prevention of early complications, such as tumor lysis syndrome, in Burkitt lymphoma 5.
Factors Contributing to Tumor Lysis Syndrome
- The high proliferation rate of Burkitt's lymphoma contributes to the risk of tumor lysis syndrome 3.
- Metabolic imbalances, such as hyperuricemia, occur as large numbers of malignant cells are lysed during cytotoxic chemotherapy, leading to tumor lysis syndrome 3.
Prevention and Treatment of Tumor Lysis Syndrome
- Standard treatment for tumor lysis syndrome includes adjustments in the chemotherapy regimen, vigorous hydration, administration of a uric acid synthesis inhibitor like allopurinol, and alkalinization 3.
- The administration of recombinant urate oxidase (rasburicase) has been shown to provide effective prophylaxis against hyperuricemia in pediatric and adult patients with hematologic malignancies 3.