From the Guidelines
Tumor lysis syndrome (TLS) is not directly dependent on bone marrow blast percentage alone, but rather on the tumor burden and its sensitivity to treatment. While high bone marrow blast counts in hematologic malignancies like acute leukemias can increase the risk of TLS, other factors are equally important [ 1 ]. TLS occurs when large numbers of cancer cells die rapidly, releasing their intracellular contents into the bloodstream, which can overwhelm the kidneys' excretory capacity.
Key Factors
- Large tumor burden
- High proliferation rate
- Chemosensitivity of the malignancy
- Pre-existing kidney dysfunction
- Dehydration Risk factors for TLS include these factors, and prevention and management strategies should be tailored to address them [ 1 ].
Prevention and Management
- Aggressive hydration with intravenous fluids (2-3 L/m²/day)
- Allopurinol (100-300 mg orally every 8 hours) or rasburicase (0.1-0.2 mg/kg IV) for hyperuricemia
- Electrolyte monitoring and correction While leukemias with high blast counts are high-risk for TLS, other malignancies with low or no bone marrow involvement, such as high-grade lymphomas or bulky solid tumors, can also develop TLS if they have a large tumor burden and are highly sensitive to treatment [ 1 ].
From the Research
Tumor Lysis Syndrome (TLS) and Bone Marrow Blasts
- TLS is a clinical condition caused by the massive lysis of tumor cells, leading to the release of intracellular contents and potentially life-threatening complications 2, 3, 4, 5, 6.
- The syndrome is highly associated with rapidly proliferating tumors, such as acute lymphoblastic leukemia and high-grade non-Hodgkin lymphoma 2.
- TLS can occur after any type of neoplasm, including solid tumors, although it is rare in the treatment of adult solid tumors 3.
- The presence of bone marrow blasts is not explicitly stated as a dependency for TLS in the provided studies.
- However, the studies suggest that TLS is more common in patients with rapidly growing hematologic malignancies, which may involve bone marrow blasts 2, 5.
- Risk factors for TLS include increased LDH, hyperuricemia, and pretreatment azotemia, but bone marrow blasts are not specifically mentioned as a risk factor 3, 4, 5, 6.
TLS Prevention and Treatment
- Prevention and treatment measures for TLS include intravenous hydration, use of allopurinol and rasburicase, management of TLS-associated electrolyte abnormalities, and renal replacement therapy 2, 4, 6.
- Identifying patients at high risk for developing TLS and prevention in high-risk patients remain an important aspect in the treatment of cancer patients 4, 5, 6.
- Rasburicase, a recombinant urate oxidase, rapidly and effectively reduces hyperuricemia, which subsequently significantly decreases the risk of acute renal failure and other clinical manifestations of TLS 4.