Tumour lysis syndrome treatment algorithm bmj best. Tumor lysis syndrome tls is a potentially fatal complication of induction therapy for several types of malignancies. A pattern of metabolic derangements occurs as a result of a massive release of intracellular contents. Spontaneous tumor lysis syndrome is a rare oncological emergency associated with multiorgan failure. Tumor cytotoxicity releases intracellular contents, including nucleic acids, proteins, and electrolytes into the systemiccirculation and may lead to development of hyperuricemia, hyperphosphatemia, hy. Guidelines for the management of tumour lysis syndrome 1. Tumour lysis syndrome symptoms, diagnosis and treatment. Tumor lysis syndrome tls is a potentially lifethreatening complication of induction chemotherapy for treatment of childhood malignancies, in particular, lymphoproliferative malignancies. The tumor lysis syndrome is the most common diseaserelated emergency.
Pdf tumor lysis syndrome tls is an oncologic emergency triggered by the rapid release of intracellular material from lysing malignant cells. Clinicians should stratify every hospitalized cancer patient and especially those receiving chemotherapy for the risk of tumor lysis syndrome. 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. When cancer cells break down quickly in the body, levels of uric acid, potassium, and phosphorus rise. Acute tumor lysis syndrome triggered by zoledronic acid in a patient with metastatic lung adenocarcinoma. Guidelines for the management of tumour lysis syndrome in. Tumor lysis syndrome tls in adult patients page 1 of 7. Tumor lysis syndrome tls is the most common lifethreatening oncological emergency encountered by physicians treating children with lymphoproliferative malignancies. Allopurinol is a structural analog of hypoxanthine and a competitive inhibitor of xanthine oxidase. Tumor lysis syndrome tls is an acute, lifethreatening disease among adults and children that is associated with the initiation of cytoreductive therapy in the treatment of malignancy. Tumor lysis syndrome tls in adult patients page 1 of 7 disclaimer.
Karen iyere is a clinical nurse at the veterans administration medical center in decatur, ga. Tumor lysis syndrome tls describes the clinical and laboratory sequelae that result from the rapid release of intracellular contents of dying cancer cells. Tumor lysis syndrome tls is an oncologic emergency resulting from rapid cancer cell destruction as a result of spontaneous tumor necrosis or treatmentrelated cell lysis. This occurs most commonly after the treatment of lymphomas and leukemias. Guidelines for the management of pediatric and adult tumor lysis syndrome. Tumor lysis syndrome tls is a cancer chemotherapyassociated oncologic emergency. Cureus spontaneous tumor lysis syndrome in diffuse large. Concomitant metabolic abnormalities characterizing this syndrome. It is the single most common oncologic emergency and a frequent source of inpatient consultation for nephrologists 1. If they cant keep up, you can develop something called tumor lysis syndrome tls.
Tumor lysis syndrome hematology jama oncology jama. Tumor lysis syndrome associated with urothelial cancer. Guidelines for the management of pediatric and adult tumor. Most oncologic emergencies can be classified as metabolic, hematologic, structural, or side effects from chemotherapy agents. This makes the most sense in the context of patients whose uric acid level is already elevated.
The tumor lysis syndrome is the most common diseaserelated emergency in children and adults with hematologic cancers. Tumor lysis syndrome sometimes happens after cancer treatment destroys tumors. Tumor lysis syndrome tls is an oncologic emergency with limited treatment options. Although the vast majority of tls is associated with rapidly proliferating hematologic malignancies, it is often overlooked in solid tumor cases and has only been rarely associated with urothelial carcinomas. 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. 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. Guidelines for the management of tumour lysis syndrome. Tumor lysis syndrome tls is a lifethreatening oncologic emergency that occurs when cancer cells break down, either spontaneously or after initiation of cytotoxic chemotherapy, and release their intracellular contents into the bloodstream.
It can induce leukostasis, tumor lysis syndrome and disseminated intravascular coagulopathy and has significant prognostic implications with. Tls can become lifethreatening if is not managed or treated. Tumor lysis syndrome refers to the constellation of metabolic disturbances that may follow the initiation of cancer treatment. 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. Roberta kaplow is an oncology clinical nurse specialist at emory university hospital in atlanta, ga. 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. Keywords hypercalcemia tumor lysis syndrome lymphoma paraneoplastic syndrome. Treatment of oncologic emergencies american family physician. Stratify pediatric patients with cancer according to risk of. This is expensive, but potentially is the most effective medication for protecting against purine metabolites. It usually occurs in patients with bulky, rapidly proliferating, treatmentresponsive tumors.
Dying cells release large amounts of potassium, phosphate, and uric acid into the blood. Healthcare providers should be aware of the condition in order to prevent occurrence and prompt timely management to avoid severe consequences. Tumor lysis syndrome tls was first described in 1929 by bedrna and polcak in patients with chronic leukemia. This can cause heart or kidney problems and lead to kidney failure. When cancer cells break down quickly in the body, levels of uric acid, potassium, and phosphorus rise faster than the kidneys can remove them. Where can the nccn treatment guidelines for tumor lysis.
Tumor lysis syndrome is a lifethreatening condition where the extensive destruction of tumor cells leads to the release of potassium, uric acid, and phosphate into the blood, leading to lifethreatening complications such as renal failure, metabolic derangements, seizures, and death. Nucleic acids break down to uric acid, leading to hyperuricemia in patients. Tumor lysis syndrome tls describes the clinical and laboratory sequelae that result from the rapid release of intracellular contents of dying. Tumor lysis syndrome hydration, allopurinol, and judicious use of sodium bicarbonate is effective single dose of recombinant urate oxidase can be considered if pt cannot take po.
Tumor lysis syndrome tls is a constellation of metabolicabnormalitiesresultingfromeitherspontaneousorchemotherapyinducedtumorcelldeath. Tumor lysis syndrome tls is a constellation of metabolic. Patients with indolent nonhodgkins lymphoma or low proliferating malignancies are at low risk. Although there have recently been substantial developments in cancer chemotherapy, these may increase the risk of tls. 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 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. It is characterized by an elevation of uric acid, hyperphosphatemia, hypocalcemia, hyperkalemia and renal failure in the setting of no active chemotherapy as a result of lysis of massive tumor burden. Control of plasma uric acid in adults at risk for tumor lysis syndrome. 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. Bedrna and polcak in patients with chronic leukemia. Hyperphosphatemia may lead to hypocalcemia with resultant tetany or other potentially lifethreatening complications. 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. When cancerous tumors break down very quickly, your kidneys have to work extra hard to remove all the substances that were in those tumors. Background tumor lysis syndrome tls results from massive lysis of rapidly proliferating malignant cells, and is characterized by hyperuricemia, hyperkalemia, and hyperphosphatemia. Tumor lysis syndrome american society of nephrology. It is characterised by excessive cell lysis resulting in hyperuricaemia, hyperphosphataemia, hyperkalaemia, and hypocalcaemia. Abualfa, md,1 and anas younes, md2 tumor lysis syndrome tls describes a constellation of biochemical and clinical abnormalities. Tumor lysis syndrome american academy of pediatrics.
Tumor lysis syndrome tls is an oncologic emergency caused by massive tumor cell death with the release of large amounts of potassium, phosphate, and nucleic acids into systemic circulation. Pdf tumor lysis syndrome in lymphoblastic crisis of cml. Early recognition of the disease and prompt management would affect morbidity and mortality. Tumor lysis syndrome tls was first described in 1929 by. Tumor lysis syndrome is triggered by rapid, acute cell lysis caused by cancer treatment. It is often associated with chemotherapy but can also occur after radiation and biologic. Tumor lysis syndrome is a rare case that may happen rapidly or spontaneously. Tls occurs mostly after the initiation of cytotoxic therapy. 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 in childhood malignancies drugs in. Healthcare providers should be aware of the condition in order to prevent occurrence and prompt. Catabolism of the nucleic acids to uric acid leads to hyperuricemia, and the marked increase in uric acid excretion can result in the. Catabolism of the nucleic acids to uric acid leads to hyperuricemia.
Tumour lysis syndrome tls is defined as a combination of metabolic and electrolyte abnormalities that occurs in patients with cancer, usually after the initiation of cytotoxic treatment but also spontaneously. Tumor lysis syndrome an overview sciencedirect topics. This report describes a case of hypercalcemia in tls in a patient with diffuse large b cell lymphoma. What oncology nurses need to know about tumor lysis syndrome. Tumor cell destruction an overview sciencedirect topics. Abstract tumor lysis syndrome tls is characterized by hyperkalemia, hyperuricemia, hypocalcemia and hyperphosphatemia. If tumors break down too quickly, the kidneys may have trouble.
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