Tumor lysis syndrome resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Definition
Tumor lysis syndrome (TLS) is a group of metabolic abnormalities resulting from rapid lysis of malignant cells and massive release of cell breakdown products into blood. It is a life threatening condition and an oncologic emergency. Metabolic complications include hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia and hyperuricosuria.
Causes
Life Threatening Causes
Tumor lysis syndrome resulting from any cause is a life threatening condition and needs immediate management.
Common Causes
Commonly tumor lysis syndrome is precipitated by chemotherapy in patients with hematologic malignancies.
- Burkitt's lymphoma
- Acute myeloid leukemia
- Acute lymphoblastic leukemia
- Chronic lymphocytic leukemia
- Chronic myeloid leukemia
- Non-Hodgkin's lymphoma
- Multiple myeloma
Classification
Cairo and Bishop classified and graded TLS as laboratory tumor lysis syndrome (LTLS) and clinical tumor lysis syndrome (CTLS).
Cairo and Bishop Definition for Laboratory Tumor Lysis Syndrome (LTLS)
LTLS is considered to be present if 2 or more following serum abnormalities are present within 3 days or 7 days after cytotoxic therapy.
| Element | Value | Change from baseline |
| Uric acid | ≥476 μmol/L or 8 mg/dL | 25 % increase |
| Potassium | ≥6 mmol/L or 6mg/L | 25 % increase |
| Phosphorus | ≥2.1 mmol/L for children ≥1.45 mmol/L for adults |
25 % increase |
| Calcium | ≤1.75 mmol/L | 25% decrease |
Cairo and Bishop Definition and Grading for Clinical Tumor Lysis Syndrome (CTLS)
Clinical tumor lysis syndrome is said to be present if LTLS is present plus 1 or more of the following clinical correlations:
| Complication | Grade | |||||
| 0 | 1 | 2 | 3 | 4 | 5 | |
| Creatinine | ≤1.5×ULN | 1.5×ULN | >1.5-3.0×ULN | >3-6×ULN | >6×ULN | Death |
| Cardiac arrhythmia | None | Intervention not indicated | Medical intervention indicated, but not urgently |
Controlled with a device or symptomatically and incompletely controlled medically |
Life threatening | Death |
| Seizure | None | - | One well controlled generalized seizure OR infrequent multiple focal motor seizures not affecting activities of daily living |
poorly controlled seizure disorder, seizure with altered consciousness |
Status epilepticus, intractable epilepsy |
Death |
Management
Shown below is an algorithm summarizing the approach to [[disease name]].