From the Guidelines
Tumor lysis syndrome (TLS) is characterized by a set of metabolic derangements caused by the massive and abrupt release of cellular components into the blood after the rapid lysis of malignant cells, and its parameters include hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and uremia.
Parameters for TLS
The following are considered parameters for TLS:
- Hyperuricemia: elevated uric acid levels (>8 mg/dL in children and >10 mg/dL in adults) 1
- Hyperkalemia: elevated potassium levels
- Hyperphosphatemia: elevated phosphorus levels
- Hypocalcemia: decreased calcium levels
- Uremia: elevated urea levels
High-Risk Factors
Patients at high risk of developing TLS carry at least one of the following factors:
- Host-related factors: dehydration, hyponatremia, pre-existing renal impairment, obstructive uropathy, hyperuricemia 1
- Disease-related factors: bulky disease, high-grade lymphomas, acute lymphoblastic leukemia, elevated serum LDH (>2 upper normal limit) 1
- Therapy-related factors: intensive polychemotherapy, including cisplatin, cytosine arabinoside, etoposide, methotrexate 1
Evaluation and Monitoring
The following evaluations should be made before starting TLS prophylaxis:
- Creatinine clearance (or estimated GFR) and serum LDH levels in all patients 1
- Renal ultrasound in all patients undergoing chemotherapy 1 Patients who experienced TLS during previous treatments should be closely monitored 1.
Treatment and Prophylaxis
Rasburicase prophylaxis is recommended for patients with a high risk of developing TLS, and urinary alkalinization is no longer recommended 1. Intractable fluid overload, hyperkalemia, hyperuricemia, hyperphosphatemia, or hypocalcemia are indications for renal dialysis 1.
From the Research
Parameters for Tumor Lysis Syndrome
The parameters for tumor lysis syndrome include:
- Hyperuricemia
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia
- Renal injury with an elevated creatinine 2, 3, 4, 5, 6
Biochemical Abnormalities
Tumor lysis syndrome is characterized by biochemical abnormalities, including:
- Hyperuricemia: elevated levels of uric acid in the blood
- Hyperkalemia: elevated levels of potassium in the blood
- Hyperphosphatemia: elevated levels of phosphate in the blood
- Hypocalcemia: decreased levels of calcium in the blood 2, 3, 4, 5, 6
Clinical Outcome
The clinical outcome of tumor lysis syndrome is directly related to these biochemical abnormalities, and can lead to life-threatening conditions such as acute kidney injury and sudden death if not treated promptly 2, 3, 4, 5, 6
Risk Assessment
Assessment of disease-specific risk level for tumor lysis syndrome in patients receiving anti-tumoral therapy is essential for early diagnosis and prevention 4, 6