Tumor Lysis Syndrome
Pathophysiology, Risk Factors, Management Strategies, and Prognostic Indicators
DOI:
https://doi.org/10.58877/japaj.v1i3.85Abstract
Tumor lysis syndrome (TLS) is an oncological emergency that occurs when cancer cells are rapidly destroyed, causing metabolic disturbances and potentially life-threatening complications. It is essential to promptly prevent and recognize TLS to ensure effective management. TLS can lead to endothelial dysfunction, hyperuricemia, and/or acute renal failure. Additionally, it commonly manifests as metabolic imbalances such as hyperkalemia, hyperphosphatemia, and hypocalcemia. In this review, we aim to offer a comprehensive understanding of TLS, including its epidemiology, pathophysiology, risk factors, and clinical presentation.
References
-Howard, S. C., Jones, D. P., & Pui, C.-H. (2011). The Tumor Lysis Syndrome. New England Journal of Medicine, 364(19), 1844–1854. doi: 10.1056/NEJMra0904569. DOI: https://doi.org/10.1056/NEJMra0904569
-Perazella, M. A., & Herlitz, L. C. (2021). The Crystalline Nephropathies. Kidney International Reports, 6(12), 2942–2957. doi: 10.1016/j.ekir.2021.09.003. DOI: https://doi.org/10.1016/j.ekir.2021.09.003
-Cai, W., Duan, X.-M., Liu, Y., Yu, J., Tang, Y.-L., Liu, Z.-L., Jiang, S., Zhang, C.-P., Liu, J.-Y., & Xu, J.-X. (2017). Uric Acid Induces Endothelial Dysfunction by Activating the HMGB1/RAGE Signaling Pathway. Oxidative Medicine and Cellular Longevity, 2017, 4391920. doi: 10.1155/2017/4391920 DOI: https://doi.org/10.1155/2017/4391920
-Verzola, D., Ratto, E., Villaggio, B., Parodi, E. L., Pontremoli, R., Garibotto, G., & Viazzi, F. (2014). Uric Acid Promotes Apoptosis in Human Proximal Tubule Cells by Oxidative Stress and the Activation of NADPH Oxidase NOX 4. PLOS ONE, 9(12), e115210. doi: 10.1371/journal.pone.0115210 DOI: https://doi.org/10.1371/journal.pone.0115210
-Adeyinka, A., & Bashir, K. (2022, October 31). Tumor Lysis Syndrome. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459262/.
-Cairo, M. S., & Bishop, M. (2004). Tumour lysis syndrome: new therapeutic strategies and classification. British Journal of Haematology, 127(1), 3-11. doi: 10.1111/j.1365-2141.2004.05094.x DOI: https://doi.org/10.1111/j.1365-2141.2004.05094.x
-Puri, I., Sharma, D., Gunturu, K. S., & Ahmed, A. A. (2020). Diagnosis and management of tumor lysis syndrome. Journal of Community Hospital Internal Medicine Perspectives, 10(3), 269–272. doi: 10.1080/20009666.2020.1761185 DOI: https://doi.org/10.1080/20009666.2020.1761185
-Cairo, M. S., Coiffier, B., Reiter, A., & Younes, A. (2010). Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Review, British Journal of Haematology, 149(4), 578-586. doi: 10.1111/j.1365-2141.2010.08143.x.** DOI: https://doi.org/10.1111/j.1365-2141.2010.08143.x
-Baeksgaard, L., & Sørensen, J. B. (2003). Acute tumor lysis syndrome in solid tumors—a case report and review of the literature. Cancer Chemotherapy and Pharmacology, 51, 187-192. doi: 10.1007/s00280-002-0551-2 DOI: https://doi.org/10.1007/s00280-002-0556-x
-Al Bagshi, M., Sadek, A. O., Hassan, E. S., & Abbas, A. A. (2013). Tumor lysis syndrome in children with acute leukemia: Incidence and outcome. Journal of Clinical Neonatology, 4(3), 100-103. Retrieved from [Al Bagshi: Tumor lysis syndrome in children with... - Google Scholar] DOI: https://doi.org/10.4103/1658-5127.123304
-Ebellins Tabares Calvache, Allison Dessiret Tabares Calvache, Cristiane Seganfredo Weber, Tumor lysis syndrome in hematological inpatients, experience from a university hospital in Brazil: A retrospective cohort study, Hematology, Transfusion and Cell Therapy, 2023, , ISSN 2531-1379, https://doi.org/10.1016/j.htct.2023.02.005. (https://www.sciencedirect.com/science/article/pii/S2531137923000743) DOI: https://doi.org/10.1016/j.htct.2023.02.005
-Ansari, M. A. (2012). Tumour lysis syndrome in haematological malignancies. JLUMHS, 11(2), 84.
- Darmon, M., Vincent, F., Camous, L., Canet, E., Bonmati, C., Braun, T., Caillot, D., Cornillon, J., Dimicoli, S., Etienne, A., et al. (2013). Tumour lysis syndrome and acute kidney injury in high-risk haematology patients in the rasburicase era: A prospective multicentre study from the Groupe de Recherche en Réanimation Respiratoire et Onco-Hématologique. British Journal of Haematology, 161(5), 666-674. https://doi.org/10.1111/bjh.12415 DOI: https://doi.org/10.1111/bjh.12415
-Ejaz, A. A., Pourafshar, N., Mohandas, R., Smallwood, B. A., Johnson, R. J., Hsu, J. W., & Kunze, G. (2015). Uric Acid and the Prediction Models of Tumor Lysis Syndrome in AML. PLoS One, 10(3), e0119497. doi: 10.1371/journal.pone.0119497. PMID: 25775138. PMCID: PMC4361475. DOI: https://doi.org/10.1371/journal.pone.0119497
-Rampello, E., Fricia, T., & Malaguarnera, M. (2006). The management of tumor lysis syndrome. Nature Reviews Clinical Oncology, 3, 438–447. doi: 10.1038/ncponc0581.
- Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008 Jun 1;26(16):2767-78. doi: 10.1200/JCO.2007.15.0177. Erratum in: J Clin Oncol. 2010 Feb 1;28(4):708. PMID: 18509186. DOI: https://doi.org/10.1200/JCO.2007.15.0177
- Alakel N, Middeke JM, Schetelig J, Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther. 2017 Feb 2;10:597-605. doi: 10.2147/OTT.S103864. PMID: 28203093; PMCID: PMC5295804. DOI: https://doi.org/10.2147/OTT.S103864
- Martens KL, Khalighi PR, Li S, White AA, Silgard E, Frieze D, Estey E, Garcia DA, Hingorani S, Li A. Comparative effectiveness of rasburicase versus allopurinol for cancer patients with renal dysfunction and hyperuricemia. Leuk Res. 2020 Feb;89:106298. doi: 10.1016/j.leukres.2020.106298. Epub 2020 Jan 7. PMID: 31945598. DOI: https://doi.org/10.1016/j.leukres.2020.106298
- Bellos I, Kontzoglou K, Psyrri A, Pergialiotis V. Febuxostat administration for the prevention of tumour lysis syndrome: A meta-analysis. J Clin Pharm Ther. 2019 Aug;44(4):525-533. doi: 10.1111/jcpt.12839. Epub 2019 Apr 10. PMID: 30972811. DOI: https://doi.org/10.1111/jcpt.12839
- Kenneth R. Hande, in Encyclopedia of Cancer (Second Edition), 2002
- Imani M, Shahmohamadnejad S. Recombinant production of Aspergillus Flavus uricase and investigation of its thermal stability in the presence of raffinose and lactose. 3 Biotech. 2017 Jul;7(3):201. doi: 10.1007/s13205-017-0841-3. Epub 2017 Jun 30. PMID: 28667645; PMCID: PMC5493577 DOI: https://doi.org/10.1007/s13205-017-0841-3
- Lakra, R., Grewal, U. S., Dhaliwal, L., Gaddam, S. J., Master, S. R., & Ramadas, P. (2022). Patients Receiving Rasburicase for Treatment and Prophylaxis of Tumor Lysis Syndrome Are Under-Tested for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency: A Single Center Retrospective Analysis. Blood, 140(Supplement 1), 11054–11055. https://doi.org/10.1182/blood-2022-170490. DOI: https://doi.org/10.1182/blood-2022-170490
- Latha SM, Krishnaprasadh D, Murugapriya P, Scott JX. Single dose rasburicase in the management of tumor lysis syndrome in childhood acute lymphoblastic leukemia: A case series. Indian J Nephrol. 2015 Mar-Apr;25(2):91-4. doi: 10.4103/0971-4065.139092. PMID: 25838646; PMCID: PMC4379632. DOI: https://doi.org/10.4103/0971-4065.139092
- Rampello E, Fricia T, Malaguarnera M. The management of tumor lysis syndrome. Nat Clin Pract Oncol. 2006 Aug;3(8):438-47. doi: 10.1038/ncponc0581. PMID: 16894389. DOI: https://doi.org/10.1038/ncponc0581
- Li T, Vijayan A. Insulin for the treatment of hyperkalemia: a double-edged sword? Clin Kidney J. 2014 Jun;7(3):239-41. doi: 10.1093/ckj/sfu049. PMID: 25852882; PMCID: PMC4377764. DOI: https://doi.org/10.1093/ckj/sfu049
- Mushiyakh Y, Dangaria H, Qavi S, Ali N, Pannone J, Tompkins D. Treatment and pathogenesis of acute hyperkalemia. J Community Hosp Intern Med Perspect. 2012 Jan 26;1(4). doi: 10.3402/jchimp.v1i4.7372. PMID: 23882341; PMCID: PMC3714047. DOI: https://doi.org/10.3402/jchimp.v1i4.7372
- College of Emergency Physicians. (n.d.). Pharmacology of hyperkalemia [PDF document]. Retrieved from https://www.acep.org/siteassets/sites/acep/media/hyperk/documents/pharmacology.pdf
- C. Ben Salem and others, Drug-induced hyperuricaemia and gout, Rheumatology, Volume 56, Issue 5, May 2017, Pages 679–688, https://doi.org/10.1093/rheumatology/kew293 DOI: https://doi.org/10.1093/rheumatology/kew293
- National Center for Biotechnology Information. (n.d.). Thiazide Diuretics - StatPearls - NCBI Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532918/#:~:text=Thiazide%20diuretics%20cause%20hyperuricemia%20and,exchanger%20on%20the%20luminal%20membrane. (Last Update: January 23, 2023)
- Ñamendys-Silva SA, Arredondo-Armenta JM, Plata-Menchaca EP, Guevara-García H, García-Guillén FJ, Rivero-Sigarroa E, Herrera-Gómez A. Tumor lysis syndrome in the emergency department: challenges and solutions. Open Access Emerg Med. 2015 Aug 20;7:39-44. doi: 10.2147/OAEM.S73684. PMID: 27147889; PMCID: PMC4806807. DOI: https://doi.org/10.2147/OAEM.S73684
- Jones GL, Will A, Jackson GH, Webb NJ, Rule S; British Committee for Standards in Haematology. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015 Jun;169(5):661-71. doi: 10.1111/bjh.13403. Epub 2015 Apr 15. PMID: 25876990. DOI: https://doi.org/10.1111/bjh.13403
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 JAPA Academy Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.