Although it is most frequently associated with the treatment of hematological malignancies, its frequency may be increasing among patients with solid tumors. A bone marrow biopsy at diagnosis showed 30% to 35% interstitial and focally diffuse involvement. Guidelines for the management of tumour lysis syndrome 1. Abnormality in 2 or more of the following, occurring within 3d before or 7d after chemo. 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. Tumor lysis syndrome sometimes happens after cancer treatment destroys tumors. As a result, tls can pose potentially lifethreatening. Elitek rasburicase for managing uric acid levels when. Tumor lysis syndrome may also occur in other hematologic malignancies and in a variety of solid tumors such as hepatoblastoma and stage iv neuroblastoma. Obinutuzumab pretreatment abrogates tumor lysis risk while. However, issues related to the syndrome continue to evolve and the oncology nurse plays a key role in the prevention and early recognition of tls as well as the identification of appropriate interventions for the patient at risk of tls.
Tumor lysis syndrome tls is a constellation of metabolic abnormalities. Patients at high risk for the development of tumor lysis syndrome should be. Usually occurs in patients with bulky, rapidly proliferating, and. Although optimal methods of risk classification and treatment have been dif ficult to define, uniform standards for management of the tumor lysis. Tumor lysis syndrome tls is observed mainly in the hematologic malignancies and rapid proliferating chemotherapy sensitive tumors and the lifethreatening metabolic dysfunctions if early diagnosis and treatment are not performed. Tls is an oncologic emergency caused by the rapid and massive breakdown of tumor cells, either spontaneously or after the initiation of cytoreductive therapy. 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 lysed at the same time by the treatment, releasing their contents into the bloodstream. Tumor lysis syndrome university of british columbia. Spontaneous tumour lysis syndrome in a multiple myeloma. Control of plasma uric acid in adults at risk for tumor lysis syndrome. Although tls can potentially occur with any type of. Tumor lysis syndrome tls describes the clinical and laboratory sequelae that result from the rapid release of intracellular contents of dying cancer cells. Definition of the tumor lysis syndrome in the current classification system of cairo and bishop,10 the tumor lysis syndrome can be classified as laboratory or clinical table 1.
Tumor lysis syndrome tls is a constellation of metabolicabnormalitiesresultingfromeitherspontaneousorchemotherapyinducedtumorcelldeath. We report a case of the acute tumor lysis syndrome arising from the empiric administration of stressdose glucocorticoids in a 75yearold man with an occult lymphoid malignancy. An increase in lactate dehydrogenase ldh is typically seen in patients with tls, probably because of anaerobic glucose metabolism. Dec 14, 2018 first, venetoclax might result in potentially lifethreatening tumor lysis syndrome tls, specifically in patients with high tumor burden and impaired kidney function, 7 and necessitates frequent admissions in patients at high risk. This is typically seen in hematologic cancers, but can be seen more rarely in solid tumor diseases. Ibrutinibassociated tumor lysis syndrome in a patient with. 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. Reduced administration of rasburicase for tumor lysis. Tumor lysis syndrome tls in adult patients page 1 of 7. Catabolism of the nucleic acids to uric acid leads to hyperuricemia, and the marked increase in uric acid excretion can result in the.
Stratify pediatric patients with cancer according to risk of developing tls. Background tumor lysis syndrome tls in pediatric patients is an oncologic emergency that involves complications of hematologic or solid malignancies. Tumor lysis syndrome in the course of burkitt lymphoma. Tls can occur spontaneously before cancer treatment but is more common within a week of starting treatment. Tumor cytotoxicity releases intracellular contents, including nucleic acids, proteins, and electrolytes into the systemiccirculation and may lead to development of hyperuricemia, hyperphosphatemia, hy. Intraoperative acute tumor lysis syndrome during laparoscopic splenectomy preceded by splenic artery embolization. How we treat tumor lysis syndrome semantic scholar. Tumor lysis syndrome tls is an oncologic emergency with a constellation of laboratory findings that result from the lysis of cancer cells. Tumor lysis syndrome tls is a lifethreatening oncologic. Albuterol, the most commonly used beta 2 agonist, which works by driving potassium into the cells, should be administered by a dose of 10 mg to 20 mg diluted in 4 ml of normal saline and. Tumor lysis syndrome tls is an oncologic emergency characterized by lifethreatening metabolic disturbances.
If tumors break down too quickly, the kidneys may have trouble disposing of tumor. It is characterized by the release of potassium, phosphorous, and nucleic acids from cancer cells into the blood stream, with the potential to cause hyperkalemia. Tumor lysis syndrome tls is an oncologic emergency due to the rapid lysis of tumor cells and subsequent release of large amounts of intracellular potassium, phosphate, and uric acid into the. Use of sodium bicarbonate for alkalinization of urine is currently not recommended for prevention and treatment of tumor lysis syndrome tls. Results in the release of intracellular products into the circulation.
Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Tumor lysis syndrome tls is a lifethreatening oncological emergency that is caused by the abrupt and massive lysis of cancer cells 16. Tumor lysis syndrome is a rare case that may happen rapidly or spontaneously. Abualfa, md,1 and anas younes, md2 tumor lysis syndrome tls describes a constellation of biochemical and clinical abnormalities resulting from rapid and massive tumor cell death. Patients with tls are complicated to treat and often have an unpredictable trajectory. Introduction tumor lysis syndrome tls is a lifethreatening oncological emergency that results from the rapid destruction of malignant cells. The resultant release of intracellular metabolites can lead to hyperuricemia, hyperphosphatemia, hyperkalemia, andor hypocalcemia. Tumor lysis syndrome is unknown to many neurosurgical teams. A 57yearold man was initially diagnosed with rai stage ii cll in 2004. Tumor lysis syndrome tls in adult patients md anderson.
In oncology and hematology, this is a potentially fatal complication. Tumor lysis syndrome tls in adult patients page 1 of 7 disclaimer. Management of tumor lysis syndrome and acute kidney injury. Usually occurs in patients with bulky, rapidly proliferating, and treatmentresponsive tumors. Catabolism of the nucleic acids to uric acid leads to hyperuricemia. Tumor lysis syndrome is a collection of metabolic abnormalities which results in the release of intracellular contents following the lysis of malignant cells and is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcaemia which results from massive cells death and release of intracellular uric acid, potassium and. Allopurinol is a structural analog of hypoxanthine and a competitive inhibitor of xanthine oxidase. When cancer cells break down quickly in the body, levels of uric acid, potassium, and phosphorus rise faster than the kidneys can remove them. Mar 21, 2012 identication of patients at risk for the development of tumor lysis syndrome is the most important in management so that prophylactic measures may be implemented before the initiation of therapy serum creatinine, blood urea nitrogen, sodium, potassium, calcium, phosphorous, ldh and uric acid levels should be determined before therapy and every. Tumor lysis syndrome inpatient care what you need to know. Successful prevention of tumor lysis syndrome using. Tumor lysis syndrome hematology jama oncology jama. Although there have recently been substantial developments in cancer chemotherapy, these may increase the risk of tls.
Tumor lysis syndrome tls is a cancer chemotherapyassociated oncologic emergency. This can cause heart or kidney problems and lead to kidney failure. Identication of patients at risk for the development of tumor lysis syndrome is the most important in management so that prophylactic measures may be implemented before the initiation of therapy serum creatinine, blood urea nitrogen, sodium, potassium, calcium, phosphorous, ldh and uric acid levels should be determined before therapy and every. Furthermore, its frequency is increasing among patients whose tumors were. This syndrome is largely preventable, and certainly manageable, with prompt diagnosis and appropriate intervention. What is the role of dialysis in the treatment of tumor. This condition is a group of symptoms and a complication from cancer treatment. In this study, we aimed to identify anticancer agents that increase tls risk, as classified by a tls panel consensus, using the us food and drug administration adverse event reporting system. 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. Pdf tumor lysis syndrome in lymphoblastic crisis of cml. Patients may be clinically asymptomatic in the early stages of the syndrome. High tumor burden, high serum lactate dehydrogenase ldh, volume depletion, acidconcentrated urine, and excessive urinary uric acid excretion may predispose a patient to tumor lysis syndrome. Ibrutinibassociated tumor lysis syndrome in a patient. The most common toxicity, the ontarget on tumor type, is triggered by excessive cytokine release or tumor cell death, which results in crs and tumor lysis syndrome, respectively 165, 166.
Introduction tumour lysis syndrome tls is a lifethreatening complication that arises when the rapid lysis of tumour cells leads to the release of excessive quantities of cellular contents into the systemic circulation resulting in a metabolic disturbance characterised by. It can occur within a few hours of treatment, but it is most often seen 4872 hours 23 days after treatment starts. We identified 1615 tls cases among 4 330 807 case reports covering the period from the first. Tumor lysis syndrome tls result of a high rate of cell turnover. Incidence of tumor lysis syndrome in selected studies with 100. It develops most often in patients with acute leukemia figure 4.
Tls is not limited to systemic chemotherapy, which travels throughout the body to destroy cancer cells. Spontaneous tls is uncommon occurrence in multiple myeloma mm. May 04, 2015 tumor lysis syndrome is an oncometabolic emergency resulting from rapid cell death. Tumor lysis syndrome is a condition that tends to be precipitated after a cancer treatment.
Tumor lysis syndrome tls is one of the metabolic oncologic emergencies identified by the oncology nursing society. This occurs most commonly after the treatment of lymphomas and leukemias. Tumor lysis syndrome tls is a potentially fatal complication in patients with large, rapidly proliferating tumor cell cancers that may occur after chemotherapy. The purpose of this article is to report two cases with unusual clinical manifestations and unexpected outcomes during. In such patients early consideration of renal replacement therapy is advisable. Tumor lysis syndrome in light chain multiple myeloma treated with bortezomib combination therapy hasmik minasyan, md and meaghan henrici, md first authors introduction tumor lysis syndrome tls is a potentially life threatening complication of cancer treatments that typically occurs in highly proliferative malignancies.
We define a case of a 70yearold woman patient who was found to have mm with spontaneous tls, following a. After completing this article, readers should be able to. Azotemia is often present before chemotherapy is initiated 26. Tls can become lifethreatening if is not managed or treated. Tumor lysis syndrome has been delineated and managed over the years. Tumor lysis syndrome in light chain multiple myeloma. 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. Tumour lysis syndrome usually occurs at the start of chemotherapy when a large number of tumour cells are destroyed. Tls can occur as a result of cancer treatment or spontaneously. Most other forms of acute renal failure are associated with lower uric acid and phosphorus levels. Guidelines for the management of pediatric and adult tumor. We describe a patient who developed tumor lysis syndrome tls with ibrutinib monotherapy. Tumor lysis syndrome shouldnt be taken lightly for it can provide grave effects.
Tumor lysis syndrome american academy of pediatrics. 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 hematology jama oncology jama network. Tumor lysis syndrome an overview sciencedirect topics. Tumor lysis syndrome tls is characterized by a group of metabolic derangements caused by the massive and abrupt release of cellular components into the blood after the rapid lysis of malignant cells. The tumor lysis syndrome tls is a collection of metabolic abnormalities that occur in consequence of the release of intracellular contents following lysis of tumor cells. Tumor lysis syndrome usually develops after the initiation of chemotherapy treatment. Tls reports were retrieved from the faers database, and reporting odds ratios rors were used to estimate associations between tls and old and new anticancer agents or their combinations. A dreaded complication, especially in the course of hematological malignancies, like it was the case in two of our patients operated for spinal cord compression by burkitts lymphoma. Guidelines for the management of tumour lysis syndrome.
Pdf tumor lysis syndrome tls is an oncologic emergency triggered by the rapid release of intracellular material from lysing malignant cells. Tumor lysis syndrome tls is an oncology emergency that occurs as a result of rapid tumor cell breakdown and the consequent release of massive amounts of intracellular contents, including potassium, phosphate, and uric acid, into the systemic circulation. Tumor lysis syndrome tls is a serious, sometimes lifethreatening oncologic emergency caused by rapid and massive cellular lysis and subsequent release of tumor cell contents and cytokines into. Pdf tumor lysis syndrome tls refers to the constellation of deranged metabolic state, characterized by hyperkalemia, hyperphosphatemia. Tumor destruction may be due to spontaneous or treatmentrelated causes, resulting in electrolyte and metabolic imbalances. Laboratory tumor lysis syndrome requires that two or more of the following metabolic abnormalities occur within 3 days before or up to 7 days after the initiation. The tumor lysis syndrome annals of internal medicine. Hyperkalemia, hypocalcemia, hyperphosphatemia and hyperuricemia may occur alone or in.
These metabolic disturbances lead to lifethreatening conditions and may cause sudden. Tumor lysis syndrome definition of tumor lysis syndrome by. There are more cases of spontaneous development of. Tumor lysis syndrome can occur as a consequence of tumor targeted therapy or spontaneously. Tumor lysis syndrome tls was first described in 1929 by bedrna and polcak in patients with chronic leukemia. Usually occurs in patients with bulky, rapidly proliferating, and treatment responsive tumors.
The dose of oral allopurinol for tumor lysis syndrome. Tumor lysis syndrome tls is the most common diseaserelated emergency of children or adults with hematologic cancers 14. This product can be deposited in kidneys, mediating acute kidney injury, as well as in cardiac tissue, leading to arrhythmia. Tumor lysis syndrome american society of nephrology. Overwhelms normal homeostatic mechanisms that control potassium, calcium, phosphorus and uric acid.
Tumor lysis syndrome symptoms, causes, guidelines and treatment. Tumor lysis syndrome is diagnosed clinically, with the use of laboratory parameters. The cell lysis leads to the rapid release of intracellular metabolites, including nucleic acids, proteins, phosphorus and potassium. Clinicians should stratify every hospitalized cancer patient and especially those receiving chemotherapy for the risk of tumor lysis syndrome. Acute tumor lysis syndrome triggered by zoledronic acid in a patient with metastatic lung adenocarcinoma. The tumor lysis syndrome is the most common diseaserelated emergency in children and adults with hematologic cancers.
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