Tumor lysis syndrome - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Tumor lysis syndrome (TLS) is an oncologic emergency caused by rapid breakdown of cancer cells and subsequent release of large amounts of intracellular content into the bloodstream.
The pathophysiologic manifestations of TLS can lead to acute kidney injury, cardiac arrhythmias, seizures, and neuromuscular dysfunction, which can cause considerable morbidity and in some cases death. TLS can compromise the clinical management of cancer patients.
Most commonly associated with highly proliferative, bulky, treatment-sensitive hematologic malignancies, particularly high-grade B-cell lymphoid malignancies (e.g., acute lymphoblastic leukemia and Burkitt lymphoma). Reports of TLS associated with other malignancies (including solid tumors) are increasing due to advances in cancer treatment.
Early identification of patients at risk of TLS and initiating appropriate preventive management is effective in most patients. Vigorous hydration and use of antihyperuricemic agents are the cornerstones of both prevention and treatment.

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Citations

Key Articles

Coiffier B, Altman A, Pui CH, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008 Jun 1;26(16):2767-78.[Abstract]
Jones GL, Will A, Jackson GH, et al. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015 Jun;169(5):661-71.[Abstract][Full Text]
Cairo MS, Coiffier B, Reiter A, et al. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 2010 May;149(4):578-86.[Abstract][Full Text]
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: B-cell lymphomas [internet publication].[Full Text]

Referenced Articles

1. Coiffier B, Altman A, Pui CH, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008 Jun 1;26(16):2767-78.[Abstract]
2. Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004 Oct;127(1):3-11.[Abstract][Full Text]
3. Mughal TI, Ejaz AA, Foringer JR, et al. An integrated clinical approach for the identification, prevention, and treatment of tumor lysis syndrome. Cancer Treat Rev. 2010 Apr;36(2):164-76.[Abstract]
4. Jones GL, Will A, Jackson GH, et al. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015 Jun;169(5):661-71.[Abstract][Full Text]
5. Fischer K, Al-Sawaf O, Hallek M. Preventing and monitoring for tumor lysis syndrome and other toxicities of venetoclax during treatment of chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program. 2020 Dec 4;2020(1):357-62.[Abstract][Full Text]
6. Tambaro FP, Wierda WG. Tumour lysis syndrome in patients with chronic lymphocytic leukaemia treated with BCL-2 inhibitors: risk factors, prophylaxis, and treatment recommendations. Lancet Haematol. 2020 Feb;7(2):e168-e176.[Abstract]
7. Medicines and Healthcare products Regulatory Agency. Venetoclax (Venclyxto): updated recommendations on tumour lysis syndrome (TLS). Dec 2021 [internet publication].[Full Text]
8. Williams SM, Killeen AA. Tumor lysis syndrome. Arch Pathol Lab Med. 2019 Mar;143(3):386-93.[Abstract][Full Text]
9. Montesinos P, Lorenzo I, Martin G, et al. Tumour lysis syndrome in patients with acute myeloid leukemia: identification of risk factors and development of a predictive model. Haematologica. 2008 Jan;93(1):67-74.[Abstract][Full Text]
10. Annemans L, Moeremans K, Lamotte M, et al. Incidence, medical resource utilisation and costs of hyperuricemia and tumour lysis syndrome in patients with acute leukaemia and non-Hodgkin's lymphoma in four European countries. Leuk Lymphoma. 2003 Jan;44(1):77-83.[Abstract]
11. Wössmann W, Schrappe M, Meyer U, et al. Incidence of tumor lysis syndrome in children with advanced stage Burkitt's lymphoma/leukemia before and after introduction of prophylactic use of urate oxidase. Ann Hematol. 2003 Mar;82(3):160-5.[Abstract]
12. McCroskey RD, Mosher DF, Spencer CD, et al. Acute tumor lysis syndrome and treatment response in patients treated for refractory chronic lymphocytic leukemia with short-course, high-dose cytosine arabinoside, cisplatin, and etoposide. Cancer. 1990 Jul 15;66(2):246-50.[Abstract]
13. Cany L, Fitoussi O, Boiron JM, et al. Tumor lysis syndrome at the beginning of thalidomide therapy for multiple myeloma. J Clin Oncol. 2002 Apr 15;20(8):2212.[Abstract]
14. Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin's lymphoma. Am J Med. 1993 Feb;94(2):133-9.[Abstract]
15. Nicholaou T, Wong R, Davis ID. Tumour lysis syndrome in a patient with renal-cell carcinoma treated with sunitinib malate. Lancet. 2007 Jun 9;369(9577):1923-4.[Abstract]
16. Gemici C. Tumour lysis syndrome in solid tumours. Clin Oncol (R Coll Radiol). 2006 Dec;18(10):773-80.[Abstract]
17. Baeksgaard L, Sorensen JB. Acute tumor lysis syndrome in solid tumors - a case report and review of the literature. Cancer Chemother Pharmacol. 2003 Mar;51(3):187-92.[Abstract]
18. McBride A, Westervelt P. Recognizing and managing the expanded risk of tumor lysis syndrome in hematologic and solid malignancies. J Hematol Oncol. 2012 Dec 13;5:75.[Abstract][Full Text]
19. Howard SC, Trifilio S, Gregory TK, et al. Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies: a systematic review. Ann Hematol. 2016 Mar;95(4):563-73.[Abstract]
20. McBride A, Trifilio S, Baxter N, et al. Managing tumor lysis syndrome in the era of novel cancer therapies. J Adv Pract Oncol. 2017 Nov-Dec;8(7):705-20.[Abstract][Full Text]
21. Sanagawa A, Hotta Y, Kondo M, et al. Tumor lysis syndrome associated with bortezomib: A post-hoc analysis after signal detection using the US Food and Drug Administration Adverse Event Reporting System. Anticancer Drugs. 2020 Feb;31(2):183-9.[Abstract]
22. Durani U, Hogan WJ. Emergencies in haematology: tumour lysis syndrome. Br J Haematol. 2020 Feb;188(4):494-500.[Abstract][Full Text]
23. Habib GS, Saliba WR. Tumor lysis syndrome after hydrocortisone treatment in metastatic melanoma: a case report and review of the literature. Am J Med Sci. 2002 Mar;323(3):155-7.[Abstract]
24. Fer MF, Bottino GC, Sherwin SA, et al. Atypical tumor lysis syndrome in a patient with T cell lymphoma treated with recombinant leukocyte interferon. Am J Med. 1984 Nov;77(5):953-6.[Abstract]
25. Simmons ED, Somberg KA. Acute tumor lysis syndrome after intrathecal methotrexate administration. Cancer. 1991 Apr 15;67(8):2062-5.[Abstract]
26. Glasser CL. Tumor lysis syndrome (TLS) following intrathecal chemotherapy in a child with acute myelogenous leukemia (AML). Leuk Res Rep. 2017 Oct 23;8:19-20.[Abstract][Full Text]
27. Mirrakhimov AE, Ali AM, Khan M, et al. Tumor lysis syndrome in solid tumors: an up to date review of the literature. Rare Tumors. 2014 May 13;6(2):5389.[Abstract][Full Text]
28. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011 May 12;364(19):1844-54.[Abstract]
29. Mato AR, Riccio BE, Qin L, et al. A predictive model for the detection of tumor lysis syndrome during AML induction therapy. Leuk Lymphoma. 2006 May;47(5):877-83.[Abstract]
30. Darmon M, Vincent F, Camous L, et al. Tumour lysis syndrome and acute kidney injury in high-risk haematology patients in the rasburicase era. A prospective multicentre study from the Groupe de Recherche en Réanimation Respiratoire et Onco-Hématologique. Br J Haematol. 2013 Aug;162(4):489-97.[Abstract][Full Text]
31. Jones DP, Mahmoud H, Chesney RW. Tumor lysis syndrome: pathogenesis and management. Pediatr Nephrol. 1995 Apr;9(2):206-12.[Abstract]
32. Jeha S. Tumor lysis syndrome. Semin Hematol. 2001 Oct;38(4 Suppl 10):4-8.[Abstract]
33. Davidson MB, Thakkar S, Hix JK, et al. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med. 2004 Apr 15;116(8):546-54.[Abstract]
34. Michallet AS, Tartas S, Coiffier B. Optimizing management of tumor lysis syndrome in adults with hematologic malignancies. Support Cancer Ther. 2005 Apr 1;2(3):159-66.[Abstract]
35. Cairo MS, Coiffier B, Reiter A, et al. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 2010 May;149(4):578-86.[Abstract][Full Text]
36. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: B-cell lymphomas [internet publication].[Full Text]
37. Hande KR, Hixson CV, Chabner BA. Postchemotherapy purine excretion in patients receiving allopurinol. Cancer Res. 1981 Jun;41(6):2273-9.[Abstract][Full Text]
38. Smalley RV, Guaspari A, Haase-Statz S, et al. Allopurinol: intravenous use for prevention and treatment of hyperuricemia. J Clin Oncol. 2000 Apr;18(8):1758-63 (erratum in: J Clin Oncol 2000 May;18(10):2188).[Abstract]
39. Bellos I, Kontzoglou K, Psyrri A, et al. Febuxostat administration for the prevention of tumour lysis syndrome: a meta-analysis. J Clin Pharm Ther. 2019 Aug;44(4):525-33.[Abstract][Full Text]
40. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: T-cell lymphomas [internet publication].[Full Text]
41. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma [internet publication].[Full Text]
42. Andreoli SP, Clark JH, McGuire WA, et al. Purine excretion during tumor lysis in children with acute lymphocytic leukemia receiving allopurinol: relationship to acute renal failure. J Pediatr. 1986 Aug;109(2):292-8.[Abstract]
43. Oldfield V, Perry CM. Rasburicase: a review of its use in the management of anticancer therapy-induced hyperuricaemia. Drugs. 2006;66(4):529-46.[Abstract]
44. Pui CH. Urate oxidase in the prophylaxis or treatment of hyperuricemia: the United States experience. Semin Hematol. 2001 Oct;38(4 Suppl 10):13-21.[Abstract]
45. Lopez-Olivo MA, Pratt G, Palla SL, et al. Rasburicase in tumor lysis syndrome of the adult: a systematic review and meta-analysis. Am J Kidney Dis. 2013 Sep;62(3):481-92.[Abstract]
46. Huang K, Brenner W, Prasad V. Tumor lysis syndrome: a rare but serious complication of radioligand therapies. J Nucl Med. 2019 Jun;60(6):752-5.[Abstract][Full Text]
47. Cohen LF, Balow JE, Magrath IT, et al. Acute tumor lysis syndrome. A review of 37 patients with Burkitt's lymphoma. Am J Med.1980 Apr;68(4):486-91.[Abstract]
48. Krakoff IH, Murphy ML. Hyperuricemia in neoplastic disease in children: prevention with allopurinol, a xanthine oxidase inhibitor. Pediatrics. 1968 Jan;41(1):52-6.[Abstract]
49. Yarpuzlu A. A review of clinical and laboratory findings and treatment of tumor lysis syndrome. Clin Chim Acta. 2003 Jul 1;333(1):13-8.[Abstract]
50. Patte C, Sakiroglu C, Ansoborlo S, et al. Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia, treated in the Société Francaise d'Oncologie Pédiatrique LMB89 protocol. Ann Oncol. 2002 May;13(5):789-95.[Abstract][Full Text]
51. Rampello E, Fricia T, Malaguarnera M. The management of tumor lysis syndrome. Nat Clin Pract Oncol. 2006 Aug;3(8):438-47.[Abstract][Full Text]
52. Will A, Tholouli E. The clinical management of tumour lysis syndrome in haematological malignancies. Br J Haematol. 2011 Jul;154(1):3-13.[Abstract][Full Text]
53. Tosi P, Barosi G, Lazzaro C, et al. Consensus conference on the management of tumor lysis syndrome. Haematologica. 2008 Dec;93(12):1877-85.[Abstract][Full Text]
54. Bowman WP, Shuster JJ, Cook B, et al. Improved survival for children with B-cell acute lymphoblastic leukemia and stage IV small noncleaved-cell lymphoma: a pediatric oncology group study. J Clin Oncol. 1996 Apr;14(4):1252-61.[Abstract]
55. Hummel M, Buchheidt D, Reiter S, et al. Recurrent chemotherapy-induced tumor lysis syndrome (TLS) with renal failure in a patient with chronic lymphocytic leukemia - successful treatment and prevention of TLS with low-dose rasburicase. Eur J Haematol. 2005 Dec;75(6):518-21.[Abstract]