Tumor Lysis Syndrome

Initiate a TLS prevention plan before cytotoxic, targeted, or cellular therapy when the malignancy is highly proliferative and treatment-sensitive, particularly in hematologic cancer with high disease burden. Hematologic malignancy and high tumor burden confer the highest recognized risk; TLS is also reported after immunotherapy and CAR T-cell therapy, with a systematic review reporting incidences ranging from no recorded events with ofatumumab to as high as 10% with CAR T-cell therapies. BMJ+3BMJSociety for Immunotherapy of Cancer (SITC) clinical practice ...cellStrategies for mitigating adverse events related to selective ...Wolters KluwerTumor Lysis Syndrome in a Super-responder to... - OvidKidney Internationalkidney disease in hematological malignancies and the burden of ...

Use baseline tumor burden and biochemical reserve to intensify prophylaxis. Features associated with high risk include high proliferative rate, elevated baseline uric acid, large tumor burden, chemosensitive disease, and leukocyte count greater than 50 × 10^9/L; kidney dysfunction increases the consequence of urate and phosphate accumulation. ScienceDirect+1ScienceDirectRole of intravenous allopurinol in the management of acute tumor lysis syndrome - ScienceDirectKidney Internationalkidney disease in hematological malignancies and the burden of ...

For acute myeloid leukemia receiving induction therapy, male sex, increased circulating blasts, elevated baseline uric acid, and IDH1/2 mutation were independent TLS risk factors in a retrospective cohort; venetoclax-based therapy showed a trend toward increased risk. These data support lower thresholds for intensive surveillance when several risk features coexist rather than reliance on leukemia diagnosis alone. ScienceDirectScienceDirectRisk factors and fluid management in tumor lysis syndrome of acute myeloid leukemia: A retrospective study - ScienceDirect

Use modified Cairo-Bishop criteria to classify laboratory TLS: uric acid at least 8.0 mg/dL, potassium at least 6.0 mEq/L, and abnormalities in phosphate and calcium are the defining metabolic pattern. Clinical TLS requires laboratory evidence plus acute kidney injury, cardiac arrhythmia or sudden death, or seizure; acute kidney injury is defined in the cited modified criteria as creatinine greater than 1.5 times the upper limit of normal for age and sex. BMJ+1BMJSpontaneous tumour lysis syndrome in chronic lymphocytic leukaemiaBMJA prospective, multicenter, phase-II trial of ibrutinib plus venetoclax ...

A rising uric acid concentration with elevated lactate dehydrogenase and nonobstructive oliguric or anuric acute kidney injury before cytotoxic therapy should prompt evaluation for spontaneous TLS and occult or progressive malignancy. One proposed spontaneous TLS framework uses uric acid at least 8.0 mg/dL, lactate dehydrogenase more than twice the upper limit of normal, and acute nonpostobstructive oliguric or anuric renal failure. BMJBMJSpontaneous tumour lysis syndrome in chronic lymphocytic leukaemia

Do not require hyperphosphatemia to recognize spontaneous TLS. Phosphate may be reutilized by rapidly proliferating tumor cells and therefore can be less conspicuous in spontaneous TLS, whereas hyperphosphatemia is more typical after rapid therapy-induced tumor killing. BMJBMJSpontaneous tumour lysis syndrome in chronic lymphocytic leukaemia

Use intravenous hydration, laboratory monitoring, and allopurinol or rasburicase as the core prophylactic bundle for high-risk patients. Hydration supports urinary clearance, but fluid administration must be titrated to urine output and cardiopulmonary tolerance; excessive positive fluid balance correlated with severe TLS in an AML cohort. cell+1cellStrategies for mitigating adverse events related to selective ...ScienceDirectRisk factors and fluid management in tumor lysis syndrome of acute myeloid leukemia: A retrospective study - ScienceDirect

Use allopurinol when prevention of additional uric acid formation is appropriate and the patient can take oral therapy; oral doses reported for TLS range up to 800 mg/day. Intravenous allopurinol is an option when oral administration is not feasible. ScienceDirectScienceDirectRole of intravenous allopurinol in the management of acute tumor lysis syndrome - ScienceDirect

Favor intravenous rasburicase for patients with high proliferative tumors, high baseline uric acid, large tumor burden, high-risk chemosensitive disease, or when rapid reduction of existing hyperuricemia is required. Rasburicase is a recombinant urate oxidase indicated for prophylaxis and treatment of chemotherapy-associated hyperuricemia in hemato-oncology patients at risk for TLS. ScienceDirect+1ScienceDirectRasburicase - an overview | ScienceDirect TopicsScienceDirectRole of intravenous allopurinol in the management of acute tumor lysis syndrome - ScienceDirect

Do not administer rasburicase in known glucose-6-phosphate dehydrogenase deficiency. Hemolytic anemia and methemoglobinemia have occurred after exposure, and G6PD deficiency is a contraindication. ScienceDirectScienceDirectRasburicase - an overview | ScienceDirect Topics

For high-risk AML after treatment initiation, a retrospective study recommended electrolyte monitoring every 6 hours for 72 hours. Apply similarly intensive serial monitoring when rapid tumor kill is anticipated, baseline chemistry is abnormal, or treatment includes modalities associated with abrupt response; follow uric acid, potassium, phosphate, calcium, creatinine, and urine output together. ScienceDirect+1ScienceDirectRisk factors and fluid management in tumor lysis syndrome of acute myeloid leukemia: A retrospective study - ScienceDirectBMJSociety for Immunotherapy of Cancer (SITC) clinical practice ...

Escalate immediately for potassium at least 6.0 mEq/L, ECG change, arrhythmia, seizure, progressive oliguria/anuria, or acute kidney injury meeting clinical TLS criteria. These findings indicate clinical TLS or imminent clinical TLS and require monitored management rather than outpatient observation. BMJ+2BMJSpontaneous tumour lysis syndrome in chronic lymphocytic leukaemiaBMJA prospective, multicenter, phase-II trial of ibrutinib plus venetoclax ...Kidney InternationalKDIGO 2024 Clinical Practice Guideline for the Evaluation and ...

Engage nephrology early when acute kidney injury progresses despite fluid and metabolic management or when electrolyte abnormalities are refractory. TLS is a hemato-oncologic emergency associated with spontaneous or therapy-induced cell death and can require kidney replacement therapy for severe metabolic and renal complications. ScienceDirect+1ScienceDirectRole of intravenous allopurinol in the management of acute tumor lysis syndrome - ScienceDirectKidney Internationalkidney disease in hematological malignancies and the burden of ...

Suspect spontaneous TLS in a patient with unexplained hyperuricemia, elevated lactate dehydrogenase, acute nonobstructive oliguria/anuria, and a compatible electrolyte pattern before therapy. Spontaneous TLS may be the first presentation of previously unrecognized chronic lymphocytic leukemia and has also been reported in solid tumors. BMJ+4BMJSpontaneous tumour lysis syndrome in chronic lymphocytic leukaemiaBMJSpontaneous tumour lysis secondary to gastric adenocarcinomaWolters KluwerMalignancy diseases and kidneys: A nephrologist... : Medicine - OvidWolters KluwerSpontaneous tumor lysis syndrome in a patient... - Ovidjournal chestnetCASE OF SPONTANEOUS TUMOR LYSIS SYNDROME IN A ...

In spontaneous TLS, phosphate may be normal despite substantial lysis because proliferating tumor cells can reutilize released phosphate. Therefore, a normal phosphate concentration should not delay treatment when hyperuricemia, kidney injury, potassium abnormality, and elevated lactate dehydrogenase support the diagnosis. BMJBMJSpontaneous tumour lysis syndrome in chronic lymphocytic leukaemia

Continue TLS risk assessment with newer immune-based therapies. TLS is a recognized toxicity of immunotherapies, especially in hematologic malignancy with high disease burden, and CAR T-cell therapy has reported TLS rates up to 10% in a systematic review. BMJBMJSociety for Immunotherapy of Cancer (SITC) clinical practice ...