Acute Tumor Lysis Syndrome

Abstract

Acute tumor lysis syndrome (ATLS) is a clinical entity that was first described in patients with either African or American Burkitt’s lymphoma who suffered sudden death within 2–3 days of treatment with chemotherapy.¹ Initial observations suggested that hyperkalemia and renal failure occurring secondary to massive tumor lysis were responsible for patient demise. The syndrome associated with the treatment of tumors with very high rates of growth and rapid cell turnover is now expanded to include metabolic complications of hyperuricemia, hyperkalemia, and hyperphosphatemia with accompanying hypocalcemia (for recent reviews, see Cohen et al² and Tsokos et al³) following chemotherapy. Certain of these complications, particularly hyperuricemia and renal failure, may also occur as the result of rapid cell turnover prior to treatment (see Section 2). This syndrome is almost exclusively associated with hematologic malignancies such as acute leukemia and malignant lymphoma, particularly Burkitt’s lymphoma (Table 1), diseases that have rapid cell proliferation but are also potentially curable, requiring aggressive treatment. ATLS in patients with solid tumors has been reported, however.^5,9,10