Tumor lysis syndrome

Tumor lysis syndrome refers to the constellation of metabolic disturbances that may follow the initiation of cancer treatment.It usually occurs in patients with bulky, rapidly proliferating, treatment-responsive tumors. (See Pathophysiology and Etiology.)

Although tumor lysis syndrome has been reported with virtually every type of tumor, it is typically associated with acute leukemias and high-grade non-Hodgkin lymphomas, such as Burkitt lymphoma. The syndrome has also been reported with other hematologic malignancies and with solid tumors such as hepatoblastoma and stage IV neuroblastoma.Tumor lysis syndrome arises most commonly in the setting of initial chemotherapeutic treatment, but spontaneous cases have increasingly been documented in patients with high-grade hematologic malignancies.

A potentially lethal complication of anticancer treatment, tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly, leading to the release of intracellular ions and metabolic byproducts into the systemic circulation. Clinically, the syndrome is characterized by rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute renal failure. (See Pathophysiology, Etiology, Prognosis, Presentation, and Workup.)

The main principles of tumor lysis syndrome management are (1) identification of high-risk patients with initiation of preventive therapy and (2) early recognition of metabolic and renal complications and the prompt administration of supportive care, including hemodialysis.