From the Guidelines
Tumor lysis syndrome is a potentially life-threatening condition that occurs when large numbers of cancer cells die quickly, releasing their contents into the bloodstream, characterized by hyperuricemia, electrolyte disturbances, and renal failure. This typically happens after starting cancer treatment, especially chemotherapy for rapidly growing cancers like high-grade lymphomas or leukemias 1. When cancer cells break down, they release potassium, phosphorus, and nucleic acids into the bloodstream, causing electrolyte abnormalities including hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia. These imbalances can lead to serious complications such as kidney failure, cardiac arrhythmias, seizures, and even death.
Key Characteristics of Tumor Lysis Syndrome
- Hyperuricemia
- Electrolyte disturbances (hyperkalemia, hyperphosphatemia, hypocalcemia)
- Renal failure
- Potential for cardiac arrhythmias, seizures, and death
Prevention and Treatment
Prevention and treatment involve aggressive hydration with intravenous fluids, medications like allopurinol or rasburicase to lower uric acid levels, and sometimes phosphate binders like sevelamer 1. Patients at high risk should receive increased hydration (3 L/m2 per day) and rasburicase prophylaxis 1. In severe cases, dialysis may be necessary to correct electrolyte imbalances and support kidney function. Early recognition and intervention are crucial for managing this oncologic emergency effectively.
High-Risk Patients
Patients with a high risk of developing tumor lysis syndrome, such as those with a high tumor burden or white blood cell count >100 × 10^9/L, should receive prophylactic measures before starting cancer therapy 1.
Indications for Dialysis
Intractable fluid overload, hyperkalemia, hyperuricemia, hyperphosphatemia, or hypocalcemia are indications for renal dialysis 1.
From the Research
Definition of Tumor Lysis Syndrome
Tumor lysis syndrome (TLS) is a metabolic complication that occurs when there is a rapid breakdown of cancer cells, resulting in the release of cellular components into the blood. This can lead to a range of metabolic derangements, including:
- Hyperuricemia (elevated uric acid levels)
- Hyperkalemia (elevated potassium levels)
- Hyperphosphatemia (elevated phosphate levels)
- Hypocalcemia (low calcium levels)
- Azotemia (elevated nitrogen waste products in the blood) 2, 3, 4, 5, 6
Characteristics of Tumor Lysis Syndrome
TLS is often characterized by a range of clinical manifestations, including:
- Nausea
- Anorexia
- Arrhythmias
- Renal failure 2, 3, 4, 5 It is a life-threatening emergency that typically follows the administration of chemotherapy or may occur spontaneously 5.
Risk Factors for Tumor Lysis Syndrome
The risk of developing TLS is influenced by a number of factors, including:
- Type of malignancy
- Type and intensity of anticancer treatment
- Presence of preexisting conditions, such as renal insufficiency 4 Particularly, high-risk patients who have malignancies with a high rate of cell turnover are highly sensitive to chemotherapy 4.
Prevention and Treatment of Tumor Lysis Syndrome
Prevention and treatment of TLS depend on immediate recognition of patients at risk. Measures include: