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Tumor Lysis Syndrome in the Cancer Patient

  • O’Dene Lewis
  • Stephen M. PastoresEmail author
Reference work entry

Abstract

Tumor lysis syndrome (TLS) is an onco-metabolic emergency that is triggered by lysis of tumor cells either after cytotoxic therapy or spontaneously, which results in the release of large amounts of potassium, phosphate, and uric acid into the systemic circulation. These metabolites can overwhelm normal homeostatic mechanisms in the body leading to hyperkalemia, hyperphosphatemia, hyperuricemia, secondary hypocalcemia, and their associated clinical manifestations. TLS can lead to acute kidney injury via crystal dependent (uric acid and/or calcium phosphate crystal deposits in renal tubules) and crystal independent mechanisms, resulting in increased morbidity and mortality. TLS is most commonly seen in patients being treated for hematologic malignancies such as non-Hodgkin’s lymphoma and acute lymphoblastic leukemia but may also occur in highly proliferative and sensitive solid tumors. With the advent of novel and effective new therapies for a variety of hematologic malignancies, the incidence of TLS is expected to increase. Identifying patients at risk and instituting preventative measures are key to minimize the clinical consequences of this syndrome. The cornerstone of management includes intravenous hydration, diuretics as needed, hypouricemic agents (allopurinol, rasburicase), close monitoring of electrolytes, and renal replacement therapy when indicated. In this chapter, we discuss the etiology, definition, pathophysiology, prophylaxis, and management of TLS, with an emphasis on high-risk patients who require intensive care support.

Keywords

Tumor lysis syndrome Intensive care unit Critical care oncology Uric acid Allopurinol Rasburicase Acute kidney injury 

Abbreviations

ALCL

Anaplastic large cell lymphoma

AKI

Acute kidney injury

ALC

Absolute lymphocyte count

ALL

Acute lymphoblastic leukemia

AML

Acute myeloid leukemia

CAR

Chimeric antigen receptor

CKD

Chronic kidney disease

CLL

Chronic lymphoblastic leukemia

CML

Chronic myeloid leukemia

CRRT

Continuous renal replacement therapy

FDA

US Food and Drug Administration

G6PD

Glucose-6-phosphate dehydrogenase

GFR

Glomerular filtration rate

HRD

High-risk for disease

ICU

Intensive care unit

IRD

Intermediate-risk for disease

LDH

Lactate dehydrogenase

LRD

Low-risk for disease

LTLS

Laboratory tumor lysis syndrome

NHL

Non-Hodgkin’s lymphoma

TLS

Tumor lysis syndrome

ULN

Upper limit normal

WBC

White blood cell

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Critical Care Medicine Fellow, Department of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Weill Cornell Medical CollegeNew YorkUSA

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