Tumour lysis syndrome

Last reviewed: 29 Oct 2020

Last updated: 26 Aug 2020

It is caused by rapid breakdown of large numbers of cancer cells and subsequent release of large amounts of intracellular content into the bloodstream, which overwhelms normal homeostatic mechanisms.

The pathophysiological 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. It can also compromise the clinical management of cancer patients.

Most commonly associated with highly proliferative, bulky, chemosensitive haematological malignancies, particularly high-grade B-cell lymphoid malignancies (e.g., acute lymphocytic leukaemia and Burkitt's lymphoma). However, reports of TLS associated with other malignancies (including solid tumours) are increasing due to advances in cancer treatment.

TLS can be classified as laboratory TLS (defined as the presence of two or more of the following metabolic abnormalities: hyperuricaemia, hyperphosphataemia, hyperkalaemia, or hypocalcaemia) or clinical TLS (defined as laboratory TLS with one or more of the following clinical manifestations: acute kidney injury [i.e., increased serum creatinine], cardiac arrhythmia, seizure, or sudden death).

Early identification of patients at risk of TLS and initiating appropriate preventive management is effective in most patients. Vigorous hydration in combination with hypouricaemic agents constitutes the cornerstone of both prevention and treatment.

Definition

Tumour lysis syndrome (TLS) is an oncological emergency characterised by metabolic and electrolyte abnormalities that can occur after the initiation of any cancer treatment, but can also occur spontaneously.[1] It is caused by rapid breakdown of large numbers of cancer cells and subsequent release of large amounts of intracellular content (potassium, phosphate, nucleic acids) into the bloodstream, which overwhelms normal homeostatic mechanisms resulting in hyperuricaemia, hyperphosphataemia, hyperkalaemia, and/or hypocalcaemia.

TLS is most commonly associated with highly proliferative, bulky, chemosensitive haematological malignancies, particularly high-grade non-Hodgkin's lymphoma (e.g., Burkitt's lymphoma) and acute lymphoblastic leukaemia.[1][2] However, reports of TLS associated with other types of malignancies (including solid tumours) are increasing due to advances in cancer treatment.[2][3][4][5]