Tumor Lysis Syndrome (TLS)

2nd INPATIENT, Clinic A/P, adults, Clinic A/P, Peds, Hospital A/P, Adults, Hospital A/P, Peds

-A massive tumor cell lysis → release of large amounts of potassium, phosphate, and uric acid into the systemic circulation.
-Uric acid and/or calcium phosphate crystal deposition in the renal tubules → acute kidney injury, oliguria or anuria, in some patients.
Labs: Uric acid, LDH
Prevention & Treatment
-Aggressive fluid hydration.
-Allopurinol or rasburicase.
–For patients at high-risk of TLS, use rasburicase.
–For intermediate risk of TLS, use allopurinol.
–For low risk of TLS, use hydration alone.
Monitoring
-High-risk patients:  Cardiac monitoring, monitor urine output and fluid balance, frequent serial measurement of BMP (electrolytes, creatinine), and uric acid.
Measure uric acid, phosphate, potassium, creatinine, calcium, and LDH before chemotherapy and every 6-12 hours after chemotherapy.

 

References / Further Reading

Br J Haematol. 2010 May;149(4):578-86. Recommendations for the evaluation of risk and prophylaxis of tumor lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. https://www.ncbi.nlm.nih.gov/pubmed?term=20331465

N Engl J Med. 2011 May 12;364(19):1844-54. The tumor lysis syndrome. https://www.ncbi.nlm.nih.gov/pubmed?term=21561350

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