Diagnosis and management of tumor lysis syndrome.

Abstract

Tumor lysis syndrome (TLS) is an oncological emergency characterized by a classic tetrad of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Risk assessment and prophylactic therapy is critical in preventing this oncological emergency. Treatment of established TLS involves aggressive hydration, electrolyte management, and the use of hypouricemic agents.

Role of Hypouricemic Agents in Tumor Lysis Syndrome: A Meta-Analysis

“…TLS based on laboratory identification are the two broad categories of TLS. The most adapted criteria was defined by Cairo & Bishop [1,2], which was amended by Howard in the ten years ago in 2018 [3]. Due to cell lysis in TLS, lactate dehydrogenase (LDH) was released, identified by simple blood testing and considered as one of the salient identification marker of disease progression.…”

“…Due to cell lysis in TLS, lactate dehydrogenase (LDH) was released, identified by simple blood testing and considered as one of the salient identification marker of disease progression. Tumor cells also have high phosphorus content [1,5], and the increased levels of biomarkers including calcium, which accumulates in the human body to promote nephrocalcinosis. TLS used to treat by continuous monitoring, hydration therapy, and administration of hypouricemic agents [1].…”

“…Tumor cells also have high phosphorus content [1,5], and the increased levels of biomarkers including calcium, which accumulates in the human body to promote nephrocalcinosis. TLS used to treat by continuous monitoring, hydration therapy, and administration of hypouricemic agents [1]. However, Hypouricemic agents specifically including allopurinol & Rasburicase and biomarkers accumulation responsible for the acute renal disorder [1,6,5].…”

“…TLS mostly seen in hematologic and solid malignancies, and identified by certain biochemical indicators; such as hyperuricemia, hyperkalemia, hypocalcemia etc. [1][2][3]. These biochemical indicators released from the cell because of cell lysis.…”

“…Uric acid nephropathy or acute urate nephropathy (AUAN) is the most common associated characteristic of TLS [1][2][3]. TLS appeared after administration of cytotoxic drugs or chemotherapeutic agents, used in blood malignancies like acute lymphoblastic leukemia (ALL), acute myeloid leukemia, B-cell non-Hodgkin lymphoma (NHL) or Burkitt's lymphoma [1][2][3][4]. TLS can also see if chemotherapeutic drugs used for other life-threatening conditions or often be seen without any history of chemotherapeutics, called as spontaneous TLS [3,4].…”