Abstract
Tumor lysis syndrome refers to the laboratory and clinical results of rapid breakdown of high volumes of malignant cells. Significant electrolyte disturbances, particularly hyperkalemia, hypocalcemia, and hyperphosphatemia, in tandem with severe hyperuricemia, are disease hallmarks. The most significant clinical sequelae of these disturbances include life-threatening cardiac arrhythmias, sudden death, seizures, and renal failure due to precipitation of uric acid or calcium phosphate in the renal tubules.
With the advent of more potent targeted and biological therapies, tumor lysis syndrome is being encountered in diverse oncology patient settings, with increasing incidence, and in diseases previously not considered high risk. Failure to identify and apply preventative strategies to at-risk patients may result in life-threatening complications and premature death. Once established, tumor lysis syndrome is a medical emergency that requires acute intervention but is inherently reversible with appropriate supportive measures.
In the palliative care setting, cancer patients remain at risk of tumor lysis syndrome, and clinicians should be aware of its potential at all times, particularly as its onset may be iatrogenic. Clear communication between clinicians and patients is critical in order to ensure that appropriate interventions are delivered in a timely fashion while considering a patient’s wishes delimiting ceilings of care.
This chapter provides an overview of the etiology, symptomatology, and standardized definitions of tumor lysis syndrome. We also discuss prevention, management, and special considerations in the palliative care setting.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Agha-Razii M, et al. Continuous veno-venous hemodiafiltration for the treatment of spontaneous tumor lysis syndrome complicated by acute renal failure and severe hyperuricemia. Clin Nephrol. 2000;54(1):59–63.
Berenson JR, et al. Replacement of bortezomib with carfilzomib for multiple myeloma patients progressing from bortezomib combination therapy. Leukemia. 2014;28(7):1529–36.
Bergwitz C, Jüppner H. Phosphate sensing. Adv Chronic Kidney Dis. 2011;18(2):132–44.
Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127(1):3–11.
Cairo MS, et al. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 2010;149(4):578–86.
Chaganti S, et al. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol. 2016;174(1):43–56.
Cohen LF, et al. Acute tumor lysis syndrome. A review of 37 patients with Burkitt’s lymphoma. Am J Med. 1980;68(4):486–91.
Coiffier B, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26(16):2767–78.
Cortes J, et al. Control of plasma uric acid in adults at risk for tumor lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone–results of a multicenter phase III study. J Clin Oncol. 2010;28(27):4207–13.
Fleming DR, Henslee-Downey PJ, Coffey CW. Radiation induced acute tumor lysis syndrome in the bone marrow transplant setting. Bone Marrow Transplant. 1991;8(3):235–6.
Flynn J, et al. Dinaciclib is a novel cyclin-dependent kinase inhibitor with significant clinical activity in relapsed and refractory chronic lymphocytic leukemia. Leukemia. 2015;29(7):1524–9.
Frei E, et al. Renal complications of neoplastic disease. J Chronic Dis. 1963;16(7):757–76.
Goede V, et al. Obinutuzumab plus chlorambucil in patients with CLL and coexisting conditions. N Engl J Med. 2014;370(12):1101–10.
Gojo I, et al. Clinical and laboratory studies of the novel cyclin-dependent kinase inhibitor dinaciclib (SCH 727965) in acute leukemias. Cancer Chemother Pharmacol. 2013;72(4):897–908.
Goldfinger S, Klinenberg JR, Seegmiller JE. The renal excretion of oxypurines. J Clin Investig. 1965;44(4):623–8.
Gregory GP, et al. CDK9 inhibition by dinaciclib potently suppresses Mcl-1 to induce durable apoptotic responses in aggressive MYC-driven B-cell lymphoma in vivo. Leukemia. 2015;29(6):1437–41.
Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin’s lymphoma. Am J Med. 1993;94(2):133–9.
Hochberg J, Cairo MS. Tumor lysis syndrome: current perspective. Haematologica. 2008;93(1):9–13.
Howard SC, et al. Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies: a systematic review. Ann Hematol. 2016;95(4):563–73.
Huang WS, Yang CH. Sorafenib induced tumor lysis syndrome in an advanced hepatocellular carcinoma patient. World J Gastroenterol. 2009;15(35):4464–6.
Jones GL, et al. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015;169(5):661–71.
Kalemkerian GP, Darwish B, Varterasian ML. Tumor lysis syndrome in small cell carcinoma and other solid tumors. Am J Med. 1997;103(5):363–7.
Kalff A, et al. Laboratory tumor lysis syndrome complicating LBH589 therapy in a patient with acute myeloid leukaemia. Haematologica. 2008;93(1):e16–7.
Kanchustambham V, et al. Spontaneous tumor lysis syndrome in small cell lung cancer. Cureus. 2017;9(2):1–9.
Keating MJ, et al. Early results of a chemoimmunotherapy regimen of fludarabine, cyclophosphamide, and rituximab as initial therapy for chronic lymphocytic leukemia. J Clin Oncol. 2005;23(18):4079–88.
Klinenberg JR, Goldfinger SE, Seegmiller JE. The effectiveness of the xanthine oxidase inhibitor allopurinol in the treatment of gout. Ann Intern Med. 1965;62:639–47.
Mossner E, et al. Increasing the efficacy of CD20 antibody therapy through the engineering of a new type II anti-CD20 antibody with enhanced direct and immune effector cell-mediated B-cell cytotoxicity. Blood. 2010;115(22):4393–402.
National Cancer Institute. Common terminology criteria for adverse events v4.0, NCI, NIH, DHHS. 2009. NIH publication # 09-7473.
Pfreundschuh M. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104(3):634–41.
Pro B, et al. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012;30(18):2190–6.
Riccio B, et al. Spontaneous tumor lysis syndrome in acute myeloid leukemia: two cases and a review of the literature. Cancer Biol Ther. 2006;5(12):1614–7.
Roberts AW, et al. Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med. 2016;374(4):311–22.
Rostom AY, et al. Tumor lysis syndrome following hemi-body irradiation for metastatic breast cancer. Ann Oncol: Off J Eur Soc Med Oncol. 2000;11(10):1349–51.
Saylor PJ, Reid TR. Tumor lysis syndrome after treatment of a gastrointestinal stromal tumor with the oral tyrosine kinase inhibitor sunitinib. J Clin Oncol. 2007;25(23):3544–6.
Schifter T, Cohen A, Lewinski UH. Severe tumor lysis syndrome following splenic irradiation. Am J Hematol. 1999;60(1):75–6.
Smalley RV, et al. Allopurinol: intravenous use for prevention and treatment of hyperuricemia. J Clin Oncol. 2000;18(8):1758–63.
Swerdlow SH, et al., editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2008.
Tam CS, et al. Long-term results of first salvage treatment in CLL patients treated initially with FCR (fludarabine, cyclophosphamide, rituximab). Blood. 2014;124(20):3059–64.
Wendtner C-M, et al. Final results of a multicenter phase 1 study of lenalidomide in patients with relapsed or refractory chronic lymphocytic leukemia. Leuk Lymphoma. 2012;53(3):417–23.
Yamazaki H, et al. Acute tumor lysis syndrome caused by palliative radiotherapy in patients with diffuse large B-cell lymphoma. Radiat Med. 2004;22(1):52–5.
Yeldandi AV, et al. Molecular evolution of the urate oxidase-encoding gene in hominoid primates: nonsense mutations. Gene. 1991;109(2):281–4.
Zeidner JF, et al. Randomized multicenter phase 2 study of flavopiridol (alvocidib), cytarabine, and mitoxantrone (FLAM) versus cytarabine/daunorubicin (7+3) in newly diagnosed acute myeloid leukemia. Haematologica. 2015;100(9):1172–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this entry
Cite this entry
Gregory, G.P., Shortt, J. (2019). Tumor Lysis Syndrome. In: MacLeod, R., Van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-77740-5_76
Download citation
DOI: https://doi.org/10.1007/978-3-319-77740-5_76
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-77738-2
Online ISBN: 978-3-319-77740-5
eBook Packages: Biomedical and Life SciencesReference Module Biomedical and Life Sciences