Tumor Lysis Syndrome

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Tumor Lysis Syndrome
Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) is a series of metabolic disorders caused by massive lysis of tumor cells. This clinical condition is life-threatening, and observed mainly in patients with hematological tumors, such as B-cell leukemia and Burkitt's lymphoma, who are undergoing chemotherapy. Tumor cells release their content, causing toxicities such as hyperuricemia, hyperphosphatemia and hyperkalemia, renal failure, cardiac arrhythmia, and seizure.1–6

According to Hochberg and Cairo, TLS can be classified as laboratory TLS (LTLS) or clinical TLS (CTLS).1 When serum values of uric acid, phosphate, calcium, and potassium differ by 25% of their normal values within three days prior to or seven days after starting treatment, TLS is classified as LTLS. Clinical TLS is defined as LTLS combined with one or more significant complications such as renal insufficiency, seizures, or cardiac arrhythmia.1 The incidence of CTLS is 3% to 7% for acute leukemias and 4% to 11% for lymphomas. The incidence rate increases to 25% for acute lymphoblastic leukemia and Burkitt's lymphoma.7 Timely management of TLS is a key factor in avoiding death. Treatment for TLS includes intravenous hydration, alkalinization of urine, and administration of rasburicase or allopurinol.8

Risk assessment

An international expert panel has evaluated various risk factors to generate guidelines to assess risk levels in cancer patients who may develop TLS.6 These guidelines, applicable to children and adults, are simple and easy to use for clinicians. The guidelines were generated based on a survey of literature relevant to TLS research, clinical expertise, and practice standards. The risk assessment was based on three phases. The first phase observes the presence of LTLS in patients. When patients are at risk of developing LTLS, they need to have their electrolyte levels monitored every six hours or less, based on the clinical stage. The second phase involves classifying hematological and solid tumors into low-risk disease (LRD), intermediate-risk disease (IRD), or high-risk disease (HRD). Most solid tumors were assigned the status of LRD. The use of chemotherapy could elevate the status to IRD (e.g., small cell lung cancer, neuroblastoma). In addition, tumor mass, age, and stage were evaluated and utilized for risk assessment. The third phase takes into account the state of renal function, before finally classifying patients into one of these three risk categories.6

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