Most common in rapidly growing hematologic malignancies. Tumor lysis syndrome is an oncologic emergency characterized by a spectrum of metabolic abnormalities, including hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Background tumor lysis syndrome tls in pediatric patients is an oncologic emergency that involves complications of hematologic or solid malignancies. Tumor lysis syndrome develops rapidly after effective therapy of several malignant conditions and is characterized by the rapid death of neoplastic cells, leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Although it is most frequently associated with the treatment of hematological malignancies, its frequency may be increasing among patients with solid tumors. The patient was 55yearold black man with chronic lymphocytic leukemia in whom the tumor lysis syndrome developed after rituximab and bendamustine treatment despite saline and allopurinol prophylaxis. In such patients early consideration of renal replacement therapy is advisable. The patient is severely hyperkalemic, which must be initially recognized and treated, hypocalcemic and hyperuricemic as a result of tumour lysis syndrome and the metabolic derangements must be stabilized until emergent hemodialysis is arranged. Usually results from uric acid precipitation within renal tubules. Tumor lysis syndrome definition of tumor lysis syndrome by.
Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase nael alakel,1 jan moritz middeke,1 johannes schetelig,1,2 martin bornha. Hyperuricemia hyperkalemia hyperphosphatemia hypocalcemia 3. Tumor lysis syndrome tls is an oncologic emergency frequently encountered in clinical practice. The tumor lysis syndrome is the most common diseaserelated emergency. Within 6 hours after receiving rasburicase at a dose of 0. When you buy this youll get access to the epub version, a downloadable pdf, and the ability to print the full article. When cancer cells break down quickly in the body, levels of uric acid, potassium, and. Clinicians should stratify every hospitalized cancer patient and especially those receiving chemotherapy for the risk of tumor lysis syndrome. The optimal management of acute tumor lysis syndrome is preservation of renal function and prevention of life threatening cardiac arrhythmias and neuromuscular irritability by providing the best supportive care.
This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. Tumor lysis syndrome may also occur in other hematologic malignancies and in a variety of solid tumors such as hepatoblastoma and stage iv neuroblastoma. In the middle column of table 1 page 1846, the value for ionized calcium in the hypocalcemia row should have been chronic lymphocytic leukemia in whom the tumor lysis syndrome developed after rituximab and bendamustine treatment despite saline and allopurinol prophylaxis. Cancer cells killed by therapy treatment may spill intracellular contents which may then accumulate faster than eliminated causing electrolyte and metabolic disturbances resulting to tumor lysis syndrome. Dying cells release large amounts of potassium, phosphate, and uric acid into the blood. Tls is an oncologic emergency caused by the rapid and massive breakdown of tumor cells, either spontaneously or after the initiation of cytoreductive therapy. Mar 21, 2012 tumor lysis syndrome is characterised by group of metabolic derangements caused by massive and abrupt release of cellular components into blood following rapid lysis of malignant cells characteristic findings of tumor lysis syndrome include. In cases of solid tumors, tls usually occurs spontaneously and after the initiation of anticancer therapy, and it has a high mortality rate. A condition of metabolic abnormalities that result from a spontaneous or therapyrelated cytolysis of tumor cells.
Tumor lysis syndrome is an oncometabolic emergency resulting from rapid cell death. Tumor lysis syndrome typically occurs in aggressive, rapidly proliferating lymphoproliferative disorders. Tumor lysis syndrome symptoms, causes, guidelines and treatment. The tumor lysis syndrome unc critical care learning pod. Tumour lysis syndrome ecgs for the case found here. Tumor lysis syndrome tls is an oncologic emergency that is usually seen when tumor cells undergo rapid decomposition spontaneously or, more often, in response to cytoreductive therapy with the release of large amounts of potassium. Tumor lysis syndrome differentials bmj best practice. Tumor lysis syndrome hematology jama oncology jama network. The earlier it is treated, the less likely it is to be harmful to an. A case of spontaneous tumor lysis syndrome in a patient with. Burkitt lymphoma and t cell acute lymphoblastic leukemia are commonly associated with this syndrome.
Tumor lysis syndrome refers to the metabolic disturbances hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia associated with lymphoproliferative malignancies which occur secondary to cell lysis. May 04, 2015 tumor lysis syndrome is an oncometabolic emergency resulting from rapid cell death. Tumor lysis syndrome tls is an oncologic emergency triggered by the rapid release of intracellular material from lysing malignant cells. Tumor lysis syndrome hematology jama oncology jama. Tumor lysis syndrome tls in adult patients page 1 of 7 disclaimer. Sep, 2016 the patient is severely hyperkalemic, which must be initially recognized and treated, hypocalcemic and hyperuricemic as a result of tumour lysis syndrome and the metabolic derangements must be stabilized until emergent hemodialysis is arranged. Tls commonly occurs in hematological malignancies, but it is very rare in patients with a solid tumor. This is part of the oncological emergencies in critical care for our senior residents. Tumor lysis syndrome background tumor lysis syndrome tls in pediatric patients is an oncologic emergency that involves complications of hematologic or solid malignancies. Catabolism of these nucleic acids into uric acid leads to hyperuricemia 1,2,11. Aug 11, 2011 the patient was 55yearold black man with chronic lymphocytic leukemia in whom the tumor lysis syndrome developed after rituximab and bendamustine treatment despite saline and allopurinol prophylaxis. Treat only if symptomatic increased ca leads to increased caphos deposition. Risk and prevention strategies can help avert tumor lysis syndrome. Burkitt lymphoma and t cell acute lymphoblastic leukemia are.
This patient had liver cancer and was treated with 3bp tace. Tumor lysis syndrome inpatient care what you need to know. Tumor lysis syndrome tls in adult patients page 1 of 7. The nature and severity of the metabolic alterations are variable and may be influenced by the timing and intensity of. Management of tumour lysis syndrome in adults and children. The tumor lysis syndrome occurs when tumor cells release their contents into the bloodstream, either. Tumor lysis syndrome tls was first described in 1929 by bedrna and polcak in patients with chronic leukemia. Customize your jama network experience by selecting one or more topics from the list below. Tumor lysis syndrome tls is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. Tumor lysis syndrome an overview sciencedirect topics. Tumor lysis syndrome in patients with acute myeloid leukemia. The second patient below experienced a serious tumor lysis syndrome reaction after one treatment because the 3bp destroyed so much cancer so fast. Management of tumour lysis syndrome in adults and children with haematological malignancies date.
History of dehydration and volume depletion, pulmonary embolism, bone metastases, or advanced renal failure. Rarely observed in solid tumors or without prior therapy. Tumor lysis syndrome symptoms, causes, guidelines and. Control of plasma uric acid in adults at risk for tumor lysis syndrome. It is characterized by a spectrum of metabolic derangements often including hyperuricemia, hyperphosphatemia with associated hypocalcemia, and hyperkalemia, which occur as a result of rapid cellular lysis of cancer cells. Dec 07, 2018 tumor lysis syndrome refers to the constellation of metabolic disturbances that may follow the initiation of cancer treatment. Tumor lysis syndrome is characterised by group of metabolic derangements caused by massive and abrupt release of cellular components into blood following rapid lysis of malignant cells characteristic findings of tumor lysis syndrome include. Tumor lysis syndrome tls is an oncologic emergency from the intracellular release of material in lysing malignant cells. Although it is most frequently associated with the treatment of hematological malignancies, its frequency. Tumor cytotoxicity releases intracellular contents, including nucleic acids, proteins, and electrolytes into the systemiccirculation and may lead to development of hyperuricemia, hyperphosphatemia, hy.
Tumor lysis syndrome tls is an oncologic emergency caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into systemic circulation. Usually occurs in patients with bulky, rapidly proliferating, and. Mar 10, 2008 tumor lysis syndrome tls is an oncologic emergency frequently encountered in clinical practice. Tumor lysis syndrome american society of nephrology. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The dosage of rasburicase is based on the underlying risk of tls. Prevention and treatment 15 zide diuretics should be avoided because they block tubular reabsorption of uric acid. The tumor lysis syndrome is the most common diseaserelated emergency in children and adults with hematologic cancers. Tumor lysis syndrome tls is a constellation of metabolicabnormalitiesresultingfromeitherspontaneousorchemotherapyinducedtumorcelldeath. Tumor lysis syndrome tls is an oncologic emergency that is usually seen when tumor cells undergo rapid decomposition spontaneously or, more often, in response to cytoreductive therapy with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. This can cause heart or kidney problems and lead to kidney failure. Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off at the same time by the treatment, releasing their contents into the bloodstream. Tls can become lifethreatening if is not managed or treated.
Dec 07, 2018 tumor lysis syndrome occurs most often in patients with acute leukemia with high white blood cell wbc counts and in those with highgrade lymphomas in response to aggressive treatment. Tumor lysis syndrome refers to the constellation of metabolic disturbances that may follow the initiation of cancer treatment. In some patients, tumor lysis results in acute renal failure. The patient was a 55yearold black man with chronic lymphocytic leukemia in whom the tumor lysis syndrome developed after rituximab and bendamustine treatment despite saline and allopurinol. Tumor lysis syndrome tls is a constellation of metabolic. Full text prevention and treatment of tumor lysis syndrome. Berns tumor lysis syndrome tls is an oncologic emergency triggered by the rapid release of intracellular material from lysing ma. Catabolism of the nucleic acids to uric acid leads to hyperuricemia. Acute tumor lysis syndrome and treatment response in patients treated for refractory chronic lymphocytic leukemia with shortcourse, highdose cytosine arabinoside, cisplatin, and etoposide.
The patient was transferred to the medical icu for management of acute tumor lysis syndrome. It usually occurs in patients with bulky, rapidly proliferating, treatmentresponsive tumors. The tumor lysis syndrome correspondence, n engl j med 2011. Key points tumor lysis syndrome tls is a metabolic derangement resulting from massive destruction of malignant cells, leading to electrolyte abnormalities and, consequently, renal, cardiac, and neurologic dysfunction and possibly death if left untreated symptoms of tls can occur spontaneously but usually occur within 12 to 72 hours. Describe the pathophysiology of tumour lysis syndrome. Tumor lysis syndrome tls is an oncologic emergency characterized by lifethreatening metabolic disturbances. Tumor destruction may be due to spontaneous or treatmentrelated causes, resulting in electrolyte and metabolic imbalances. Tumor lysis syndrome tls is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of. The tumor lysis syndrome is the most common diseaserelated emergency in. Cairobishop definition of laboratory tumor lysis syndrome and clinical tumor lysis syndrome. Tumor lysis syndrome is a rare case that may happen rapidly or spontaneously. Guidelines for the management of pediatric and adult tumor.
The nature and severity of the metabolic alterations are variable and may be influenced by the timing and intensity. Tumor lysis syndrome amaka edeani, md, and anushree shirali, md kidney diseases branch, national institute of diabetes and digestive and kidney diseases, national institutes of health, bethesda, maryland. How do you make the diagnosis, and what are the keys in management. Tumor lysis syndrome tls is a potentially lifethreating complication of tumors or chemotherapy treatment. The syndrome arises from the abrupt release of intracellular contents into the intravascular space following the rapid destruction of malignant cells. Tumor lysis syndrome risks, symptoms and leading causes.