Acute Tumor Lysis Syndrome: Diagnosis and Management

  • M. Darmon
  • M. Roumier
  • E. Azoulay
Conference paper


Tumor lysis syndrome is a potentially life-threatening complication of cancer treatment in patients with extensive, rapidly growing, chemosensitive malignancies. Tumor lysis syndrome results from the rapid destruction of malignant cells, which abruptly release intracellular ions, proteins, and metabolites into the extracellular space [1]. Potassium, calcium, phosphates, and uric acid, which are present in high concentrations within malignant cells, pour into the extracellular space. The result is a constellation of metabolic disturbances that can cause acute kidney injury (AKI), of which the most common mechanism is uric-acid crystal formation in the renal tubules. Another cause of AKI is calcium-phosphate deposition related to hyperphosphatemia. AKI may, in itself, cause substantial morbidity and mortality [2]. In addition, AKI leads to further increases in the above-listed metabolites, most notably potassium and phosphate, which may lead to cardiac arrhythmia or sudden death [3, 4].


Uric Acid Chronic Lymphocytic Leukemia Renal Replacement Therapy Acute Kidney Injury Tumor Lysis Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Yarpuzlu AA (2003) A review of clinical and laboratory findings and treatment of tumor lysis syndrome. Clin Chim Acta 333: 13–18CrossRefPubMedGoogle Scholar
  2. 2.
    Metnitz PG, Krenn CG, Steltzer, et al (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30: 2051–2058CrossRefPubMedGoogle Scholar
  3. 3.
    Cairo MS, Bishop M (2004) Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 127: 3–11CrossRefPubMedGoogle Scholar
  4. 4.
    Davidson MB, Thakkar S, Hix JK, et al (2004) Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med 116: 546–554CrossRefPubMedGoogle Scholar
  5. 5.
    Kalemkerian GP, Darwish B, Varterasian ML (1997) Tumor lysis syndrome in small cell carcinoma and other solid tumors. Am J Med 103: 363–367CrossRefPubMedGoogle Scholar
  6. 6.
    Altman A (2001) Acute tumor lysis syndrome. Semin Oncol 28:S3–8CrossRefPubMedGoogle Scholar
  7. 7.
    Darmon M, Thiery G, Ciroldi M, et al (2005) Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 33: 2488–2493CrossRefPubMedGoogle Scholar
  8. 8.
    Montesinos P, Lorenzo I, Martin G, et al (2008) Tumor lysis syndrome in patients with acute myeloid leukemia: identification of risk factors and development of a predictive model. Haematologica 93: 67–74CrossRefPubMedGoogle Scholar
  9. 9.
    Seegmiller JE, Laster L, Howell RR (1963) Biochemistry of uric acid and its relation to gout. N Engl J Med 268: 821–827PubMedGoogle Scholar
  10. 10.
    Seegmiller JE, Laster L, Howell RR (1963) Biochemistry of uric acid and its relation to gout. N Engl J Med 268: 764–773PubMedCrossRefGoogle Scholar
  11. 11.
    Seegmiller JE, Laster L, Howell RR (1963) Biochemistry of uric acid and its relation to gout. N Engl J Med 268: 712–716PubMedCrossRefGoogle Scholar
  12. 12.
    Conger JD, Falk SA (1977) Intrarenal dynamics in the pathogenesis and prevention of acute urate nephropathy. J Clin Invest 59: 786–793CrossRefPubMedGoogle Scholar
  13. 13.
    Flombaum CD (2000) Metabolic emergencies in the cancer patient. Semin Oncol 27: 322–334PubMedGoogle Scholar
  14. 14.
    Hebert LA, Lemann J Jr, Petersen JR (1966) Studies of the mechanism by which phosphate infusion lowers serum calcium concentration. J Clin Invest 45: 1886–1894CrossRefPubMedGoogle Scholar
  15. 15.
    Munker R, Hill U, Jehn U, et al (1998) Renal complications in acute leukemias. Haematologica 83: 416–421PubMedGoogle Scholar
  16. 16.
    Coiffier B, Altman A, Pui CH, et al (2008) Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 26: 2767–2778CrossRefPubMedGoogle Scholar
  17. 17.
    Jeha S (2001) Tumor lysis syndrome. Semin Hematol 38:S4–8CrossRefPubMedGoogle Scholar
  18. 18.
    Cohen LF, Balow JE, Magrath IT, et al (1980) Acute tumor lysis syndrome._A review of 37 patients with Burkitt’s lymphoma. Am J Med 68: 486–491CrossRefPubMedGoogle Scholar
  19. 19.
    Pui CH (2001) Urate oxidase in the prophylaxis or treatment of hyperuricemia: the United States experience. Semin Hematol 38:S13–21CrossRefPubMedGoogle Scholar
  20. 20.
    Goldman SC, Holcenberg JS, Finklestein JZ, et al (2001) A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. Blood 97: 2998–3003CrossRefPubMedGoogle Scholar
  21. 21.
    Annemans L, Moeremans K, Lamotte M, et al (2003) 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 44: 77–83CrossRefPubMedGoogle Scholar
  22. 22.
    Mato AR, Riccio BE, Qin L, et al (2006) A predictive model for the detection of tumor lysis syndrome during AML induction therapy. Leuk Lymphoma 47: 877–883CrossRefPubMedGoogle Scholar
  23. 23.
    Razis E, Arlin ZA, Ahmed T, et al (1994) Incidence and treatment of tumor lysis syndrome in patients with acute leukemia. Acta Haematol 91: 171–174CrossRefPubMedGoogle Scholar
  24. 24.
    Hussain K, Mazza JJ, Clouse LH (2003) Tumor lysis syndrome (TLS) following fludarabine therapy for chronic lymphocytic leukemia (CLL): case report and review of the literature. Am J Hematol 72: 212–215CrossRefPubMedGoogle Scholar
  25. 25.
    Fassas AB, Desikan KR, Siegel D, et al (1999) Tumour lysis syndrome complicating high-dose treatment in patients with multiple myeloma. Br J Haematol 105: 938–941CrossRefPubMedGoogle Scholar
  26. 26.
    Terpos E, Politou M, Rahemtulla A (2004) Tumour lysis syndrome in multiple myeloma after bortezomib (VELCADE) administration. J Cancer Res Clin Oncol 130: 623–625CrossRefPubMedGoogle Scholar
  27. 27.
    Yang H, Rosove MH, Figlin RA (1999) Tumor lysis syndrome occurring after the administration of rituximab in lymphoproliferative disorders: high-grade non-Hodgkin’s lymphoma and chronic lymphocytic leukemia. Am J Hematol 62: 247–250CrossRefPubMedGoogle Scholar
  28. 28.
    Cany L, Fitoussi O, Boiron JM, et al (2002) Tumor lysis syndrome at the beginning of thalidomide therapy for multiple myeloma. J Clin Oncol 20:2212PubMedGoogle Scholar
  29. 29.
    Lee CC, Wu YH, Chung SH, et al (2006) Acute tumor lysis syndrome after thalidomide therapy in advanced hepatocellular carcinoma. Oncologist 11: 87–88CrossRefPubMedGoogle Scholar
  30. 30.
    Cech P, Block JB, Cone LA, et al (1986) Tumor lysis syndrome after tamoxifen flare. N Engl J Med 315: 263–264PubMedCrossRefGoogle Scholar
  31. 31.
    Stoves J, Richardson D, Patel H (2001) Tumour lysis syndrome in a patient with metastatic melanoma treated with biochemotherapy. Nephrol Dial Transplant 16: 188–189CrossRefPubMedGoogle Scholar
  32. 32.
    Humphreys BD, Soiffer RJ, Magee CC (2005) Renal failure associated with cancer and its treatment: an update. J Am Soc Nephrol 16: 151–161CrossRefPubMedGoogle Scholar
  33. 33.
    Mehta RL, Pascual MT, Soroko S, et al (2002) Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 288: 2547–2553CrossRefPubMedGoogle Scholar
  34. 34.
    Coiffier B, Mounier N, Bologna S, et al (2003) Efficacy and safety of rasburicase (recombinant urate oxidase) for the prevention and treatment of hyperuricemia during induction chemotherapy of aggressive non-Hodgkin’s lymphoma: results of the GRAAL1 (Groupe d’Etude des Lymphomes de l’Adulte Trial on Rasburicase Activity in Adult Lymphoma) study. J Clin Oncol 21: 4402–4406CrossRefPubMedGoogle Scholar
  35. 35.
    Baeksgaard L, Sorensen JB (2003) Acute tumor lysis syndrome in solid tumors—a case report and review of the literature. Cancer Chemother Pharmacol 51: 187–192PubMedGoogle Scholar
  36. 36.
    Haas M, Ohler L, Watzke H, et al (1999) The spectrum of acute renal failure in tumour lysis syndrome. Nephrol Dial Transplant 14: 776–779CrossRefPubMedGoogle Scholar
  37. 37.
    Goldman SC (2003) Rasburicase: potential role in managing tumor lysis in patients with hematological malignancies. Expert Rev Anticancer Ther 3: 429–433CrossRefPubMedGoogle Scholar
  38. 38.
    Patte C, Sakiroglu C, Ansoborlo S, et al (2002) Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia, treated in the Societe Francaise d’Oncologie Pediatrique LMB89 protocol. Ann Oncol 13: 789–795CrossRefPubMedGoogle Scholar
  39. 39.
    Annemans L, Moeremans K, Lamotte M, et al (2003) Pan-European multicentre economic evaluation of recombinant urate oxidase (rasburicase) in prevention and treatment of hyperuricaemia and tumour lysis syndrome in haematological cancer patients. Support Care Cancer 11: 249–257PubMedGoogle Scholar
  40. 40.
    Browning LA, Kruse JA (2005) Hemolysis and methemoglobinemia secondary to rasburicase administration. Ann Pharmacother 39: 1932–1935CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • M. Darmon
    • 1
  • M. Roumier
    • 1
  • E. Azoulay
    • 1
  1. 1.Department of Intensive CareHôpital Saint-LouisParisFrance

Personalised recommendations