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Analyse et critique des recommandations britanniques 2015 de prise en charge du syndrome de lyse tumorale de l’adulte

Analysis of the British guidelines 2015 for the management of adult tumor lysis syndrome

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Médecine Intensive Réanimation

Résumé

Le syndrome de lyse tumorale (SLT) est caractérisé par le relargage massif et brutal du contenu intracellulaire de certaines cellules tumorales, avec pour conséquence des complications métaboliques sévères, pouvant entraîner une insuffisance rénale aiguë. Il se rencontre majoritairement chez les patients atteints d’hémopathie maligne mais aussi de plus en plus fréquemment chez les patients recevant un nouvel agent anticancéreux pour le traitement d’un cancer solide. Le SLT est bien connu des hématologues, mais doit intéresser également les réanimateurs, la prise en charge optimale ne se concevant qu’en collaboration étroite entre les deux spécialités. Le traitement préventif adapté au risque doit être débuté le plus rapidement possible dans un milieu permettant une surveillance optimale, afin d’épargner la fonction rénale, facteur pronostique majeur. La prise en charge, qui a fait de nombreux progrès notamment grâce à l’utilisation de la rasburicase, a fait l’objet en 2015 de recommandations britanniques, ne concernant que les hémopathies et que nous nous proposons de résumer et d’analyser dans cet article.

Abstract

Tumor lysis syndrome (TLS) refers to the massive release of the intracellular content of tumor cells, as a consequence of which there are severe metabolic derangements responsible for acute kidney injury. Occurring mainly in patients with hematological malignancies, TLS is increasingly encountered in oncological situations, mainly in patients receiving new antitumoral drugs. TLS is well known to hematologists, but intensivists must also become familiar to it, and both specialties must work in close collaboration. Risk-adapted preventive treatment should be initiated as early as possible in a department allowing close monitoring in order to preserve renal function, the main prognostic factor for survival. TLS management has greatly improved over the years, with the use of Rasburicase, and was recently the object of British recommendations focusing on hematological malignancies in 2015, which we will analyze and discuss in this paper.

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  1. Service de néphrologie, centre hospitalier Felix-Guyon (Saint-Denis), Bellepierre, F-97405, Saint-Denis cedex, France

    A. -S. Vasseur

  2. Centre de réanimation, hôpital Salengro, CHU Lille, F-59000, Lille, France

    A. -S. Moreau

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Vasseur, A.S., Moreau, A.S. Analyse et critique des recommandations britanniques 2015 de prise en charge du syndrome de lyse tumorale de l’adulte. Méd. Intensive Réa 26, 285–295 (2017). https://doi.org/10.1007/s13546-017-1284-x

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