Management of Tumor Lysis Syndrome - Episode 1

Overview of Tumor Lysis Syndrome


Michael R. Bishop, MD: Tumor lysis syndrome [TLS] is both a metabolic and a clinical entity that occurs when there is the rapid breakdown of tumor cells. When this rapid breakdown occurs, generally in the setting of a patient receiving some form of therapy for their cancer, the contents of the cells are released into the bloodstream. Particularly potassium, calcium, phosphate, and uric acid can lead to metabolic abnormalities and clinical manifestations, including kidney failure, heart arrhythmias, and in the worst-case scenario, sudden death.

Surprisingly, the incidence of TLS is relatively high. It’s particularly high in patients with hematologic malignancies, such as leukemia and lymphoma. But most important, it can be seen in almost any cancer that responds well to some form of therapy—that could be targeted therapies or chemotherapies. But the incidence among patients with hematologic malignancies is approximately 35% to 40%.

Why TLS is an oncological emergency is because it can potentially result in death. So it is considered a life-threatening oncological emergency. The reason for this primarily is the onset of renal failure. Left untreated, the incidence of renal failure can approach 24% in specific malignancies, particularly high-risk hematologic malignancies. The other abnormalities, as I have mentioned previously, are cardiac arrhythmias. It can lead to seizures and to sudden death. The long-term sequelae if a patient avoids passing away from 1 of these complications is they could be left with permanent renal damage and the potential necessity for hemodialysis.

Transcript Edited for Clarity