Tumor lysis syndrome, also known as tumor lysis syndrome (TLS), can occur in any patient with a rapid rate of tumor cell proliferation and massive and rapid destruction of tumor cells that die after treatment.
When there is massive cell destruction, intracellular material is rapidly released into the circulation, exceeding the ability of the liver to metabolize and the kidneys to excrete, causing accumulation of metabolites and resulting in hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, etc. In severe patients, acute renal failure, severe heart rate arrhythmias such as ventricular tachycardia and ventricular fibrillation, diffuse intravascular coagulation (disseminated), and acute renal failure. The patient may have acute renal failure, severe arrhythmias such as ventricular tachycardia and ventricular fibrillation, and diffuse intravascular coagulation (DIC).
Generally common during induction chemotherapy for acute leukemia, highly malignant lymphomas, especially acute lymphoblastic leukemia and Burkitt’s lymphoma/leukemia in acute leukemia, and less frequently but occasionally in patients with acute myeloid leukemia.
Clinicians first need to determine if the patient is at high risk for tumor lysis syndrome as early as possible after the disease is diagnosed, and to enhance prevention and monitoring.
For patients with high tumor load, such as high leukocytes at presentation, significant hepatosplenomegaly, and markedly elevated lactate dehydrogenase (LDH) levels, a 3- to 5-day pretreatment prior to initial chemotherapy is appropriate to reduce the tumor load, and allopurinol should be given orally during chemotherapy along with adequate hydration and alkalinization, such as intravenous sodium bicarbonate supplementation. The urine volume should be maintained at 100-150 ml/h and the urine pH should be maintained at about 7. The fluid intake and output, electrolytes and renal function should be closely monitored.