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Tumor Lysis Syndrome: Prevention and Management

Recognition, risk stratification and rasburicase-based therapy

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Tumor Lysis Syndrome: Prevention and Management?

Tumor lysis syndrome (TLS) is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia and acute kidney injury.

Cairo-Bishop laboratory and clinical criteria define TLS, with grading reflecting severity.

Highest risk populations include high-grade lymphomas (Burkitt), acute lymphoblastic leukemia, hyperleukocytic acute myeloid leukemia and bulky high-grade tumors.

Lower risk diseases (CLL, multiple myeloma) and solid tumors usually have lower TLS rates.

Newer therapies (venetoclax, CAR-T cells, targeted therapies) may also precipitate TLS.

Symptoms

Nausea, vomiting, weakness, anorexia and lethargy from electrolyte imbalance.
Muscle cramps, tetany, paresthesia and seizures from hypocalcemia.
Cardiac arrhythmias including peaked T waves, widened QRS, ventricular tachycardia or asystole due to hyperkalemia.
Decreased urine output, edema and uremic symptoms from acute kidney injury.
Calcium phosphate precipitation may aggravate kidney damage and lead to multi-organ dysfunction.

Risk Factors

High tumor burden, elevated lactate dehydrogenase, leukemic cell count above 100 000/microL.
Rapidly proliferating tumors and chemosensitive disease.
Pre-existing kidney impairment, dehydration, hyperuricemia or acidic urine.
Use of nephrotoxic agents, intravenous contrast or angiotensin blockade.
Lack of prophylaxis or inadequate hydration before cytoreductive therapy.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Patients receiving high-risk chemotherapy must be admitted for prophylaxis and monitoring.
  • New oliguria, decreased urine output, edema or rapid weight gain warrants urgent evaluation.
  • Severe muscle cramps, palpitations, syncope, seizures or altered mental status require emergency care.
  • Persistent vomiting, severe weakness or refusal of fluids needs intravenous management.
  • Emerging signs of TLS during therapy demand intensified intervention and possible nephrology consultation.

Treatment Methods

01
Risk-based prophylaxis includes intravenous hydration (2.5 to 3 L/m2 per day) starting 24 to 48 hours before chemotherapy and continuing 48 to 72 hours after.
02
Allopurinol is given to low and intermediate risk patients to inhibit xanthine oxidase and reduce uric acid formation.
03
Rasburicase (recombinant urate oxidase) is used for high-risk patients to convert uric acid to soluble allantoin; G6PD screening avoids hemolytic complications.
04
Aggressive electrolyte management corrects hyperkalemia, hyperphosphatemia and hypocalcemia; renal replacement therapy is initiated for refractory cases.
05
Post-chemotherapy monitoring includes frequent labs, fluid balance, cardiac monitoring and gradual reintroduction of withdrawn medications; multidisciplinary care with oncology, nephrology and intensive care optimizes outcomes.

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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