Tumor lysis syndrome resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]

Definition

Tumor lysis syndrome (TLS) is a group of metabolic abnormalities resulting from rapid lysis of malignant cells and massive release of cell breakdown products into blood. It is a life threatening condition and an oncologic emergency. Metabolic complications include hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia and hyperuricosuria.

Causes

Life Threatening Causes

Tumor lysis syndrome resulting from any cause is a life threatening condition and needs immediate management.

Common Causes

Commonly tumor lysis syndrome is precipitated by chemotherapy in patients with hematologic malignancies.

• Burkitt's lymphoma
• Acute myeloid leukemia
• Acute lymphoblastic leukemia
• Chronic lymphocytic leukemia
• Chronic myeloid leukemia
• Non-Hodgkin's lymphoma
• Multiple myeloma

Classification

Cairo and Bishop classified and graded TLS as laboratory tumor lysis syndrome (LTLS) and clinical tumor lysis syndrome (CTLS).

Cairo and Bishop Definition for Laboratory Tumor Lysis Syndrome (LTLS)

LTLS is considered to be present if 2 or more following serum abnormalities are present within 3 days or 7 days after cytotoxic therapy.

Element	Value	Change from baseline
Uric acid	≥476 μmol/L or 8 mg/dL	25 % increase
Potassium	≥6 mmol/L or 6mg/L	25 % increase
Phosphorus	≥2.1 mmol/L for children ≥1.45 mmol/L for adults	25 % increase
Calcium	≤1.75 mmol/L	25% decrease

Management

Shown below is an algorithm summarizing the approach to [[disease name]].

References

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