{ "schemaVersion": 2, "eyebrow": "Oncologic emergency", "title": "Tumor Lysis Syndrome", "summary": "Tumor lysis syndrome requires prospective risk stratification before cytoreduction, intensive early metabolic surveillance, rapid urate reduction when indicated, and a low threshold for renal replacement therapy when electrolyte derangements, oliguria, or volume overload become refractory.", "seoDescription": "Tumor lysis syndrome: risk assessment, diagnostic criteria, prophylaxis, rasburicase and allopurinol selection, electrolyte management, and dialysis triggers.", "clinicalQuestion": "How should physicians identify, prevent, monitor, and urgently manage tumor lysis syndrome in patients receiving anticancer therapy?", "specialty": "Hematology-Oncology", "audience": "U.S. physicians and medical trainees", "tags": [ "tumor lysis syndrome", "TLS prophylaxis", "rasburicase", "allopurinol", "hyperuricemia", "hyperphosphatemia", "acute kidney injury", "oncologic emergency" ], "keyTakeaways": [ "Assess TLS risk before therapy using tumor burden, proliferative rate, anticipated treatment sensitivity, baseline kidney function, volume status, and baseline urate and electrolyte abnormalities. [19][21]", "Clinical TLS is a metabolic emergency: rapidly address hyperkalemia, hyperphosphatemia, acute kidney injury, arrhythmia risk, and volume status while initiating urate-lowering therapy and nephrology involvement. [19][21]", "Rasburicase degrades existing uric acid and is favored for high-risk patients or established hyperuricemic TLS; avoid it in known G6PD deficiency because hemolysis and methemoglobinemia can occur. [18][19]", "Do not routinely alkalinize urine in TLS; it can promote calcium-phosphate precipitation and worsen kidney injury. [18][19]", "Early rasburicase within 12 hours of established TLS was associated with lower in-hospital kidney replacement therapy or death in a multicenter U.S. target-trial emulation; residual confounding remains possible. [4]" ], "sections": [ { "id": "risk-and-prevention", "eyebrow": "Before cytoreduction", "heading": "Identify patients needing intensive prophylaxis", "intro": "TLS prevention begins before the first cytoreductive dose, including corticosteroids, targeted agents, cellular therapy, or radiation.", "paragraphs": [ "TLS results from spontaneous or treatment-related release of intracellular potassium, phosphate, and nucleic acids. Uric acid generation and calcium-phosphate deposition can contribute to acute kidney injury (AKI); hyperkalemia and hypocalcemia can cause arrhythmias or seizures. [19][21]", "Risk is driven by disease burden, cellular proliferation and turnover, treatment sensitivity, and patient-specific clearance limitations. Large burden may include leukocytosis, bulky disease, organ infiltration, or markedly elevated lactate dehydrogenase; preexisting kidney dysfunction, dehydration, hyperuricemia, and nephrotoxin exposure increase the risk that laboratory lysis progresses to clinical TLS. [4][19][21]", "Novel targeted, immune-based, and cellular therapies have made TLS less predictable than in the conventional cytotoxic chemotherapy era. Risk assessment should therefore be regimen-specific and repeated when disease burden or treatment intensity changes. [17][21]" ], "bullets": [ "Obtain baseline potassium, phosphate, calcium, creatinine, uric acid, and lactate dehydrogenase before therapy in patients at risk; obtain an ECG when hyperkalemia or clinically significant electrolyte disturbance is present or anticipated. [16][21]", "Use prophylactic IV hydration in intermediate- or high-risk patients when cardiopulmonary status permits; monitor intake, urine output, weight, and congestion because fluid overload may worsen outcomes. [17][19][21]", "Avoid potassium and phosphate supplementation unless there is a compelling indication. [19]", "Do not use sodium bicarbonate solely to alkalinize urine for TLS prevention or treatment. [18][19]" ], "subsections": [], "table": { "caption": "Risk-directed prophylaxis and surveillance principles. Specific institutional protocols should define fluid rates, monitoring frequency, and site of care. [19][21]", "columns": [ "Risk context", "Initial prevention approach", "Monitoring and disposition" ], "rows": [ [ "Lower anticipated TLS risk", "Assess baseline renal function and metabolic profile; ensure hydration and arrange repeat laboratory testing appropriate to the regimen. [19][21]", "Outpatient monitoring may be appropriate only when disease, regimen, renal function, and reliable follow-up support it. [21]" ], [ "Intermediate risk or impaired renal reserve", "IV hydration when feasible; use a xanthine oxidase inhibitor for urate prevention when indicated; escalate to rasburicase if hyperuricemia develops or clinical/laboratory TLS emerges. [19]", "Serial electrolytes, uric acid, and kidney function during the risk window; increase monitoring and level of care for evolving abnormalities. [19][21]" ], [ "High risk or established TLS", "IV hydration with careful volume assessment plus rasburicase when not contraindicated; involve nephrology early. [19][21]", "Frequent laboratory and cardiac surveillance; inpatient management is generally required because metabolic deterioration can be rapid. [16][19][21]" ] ] } }, { "id": "diagnosis", "eyebrow": "Recognition", "heading": "Diagnose laboratory and clinical TLS while excluding mimics", "intro": "Treat the patient’s metabolic trajectory, not a single laboratory value in isolation.", "paragraphs": [ "The Cairo-Bishop framework classifies laboratory TLS by abnormalities in uric acid, potassium, phosphate, and calcium occurring around treatment initiation; clinical TLS requires laboratory TLS plus a clinically important complication such as AKI, arrhythmia, seizure, or sudden death. Adult absolute laboratory thresholds cited in contemporary reviews include uric acid at least 8 mg/dL, potassium at least 6 mEq/L, and phosphate at least 4.5 mg/dL; calcium decline is a supporting abnormality. [19][20]", "Interpret criteria in context. Baseline chronic kidney disease, pseudohyperkalemia, phosphate administration, hypocalcemia from other causes, sepsis-associated AKI, and obstructive uropathy can mimic or compound TLS. The central clinical question is whether rapid tumor-cell breakdown is producing a worsening metabolic pattern that exceeds renal clearance. [19][21]", "Spontaneous TLS occurs, particularly with high tumor burden, and should be considered before therapy when hyperuricemia accompanies hyperkalemia, hyperphosphatemia, AKI, oliguria, or rapidly rising lactate dehydrogenase. [4][18][21]" ], "bullets": [ "Obtain serial potassium, phosphate, calcium, creatinine, uric acid, bicarbonate, and lactate dehydrogenase; monitor urine output and fluid balance. [19][21]", "Use continuous or repeated ECG assessment for meaningful hyperkalemia, conduction abnormalities, or arrhythmic symptoms. [14][16][21]", "New oliguria, pulmonary edema, rising creatinine, persistent hyperphosphatemia, tetany, seizure, syncope, or arrhythmia should trigger immediate escalation rather than waiting for complete diagnostic classification. [16][19][21]" ], "subsections": [], "table": { "caption": "Metabolic pattern and immediate clinical consequence in TLS. [16][19][21]", "columns": [ "Abnormality", "Major consequence", "Immediate priority" ], "rows": [ [ "Hyperkalemia", "Potentially fatal conduction disturbance or arrhythmia. [16][19]", "ECG assessment, cardiac membrane stabilization and intracellular shifting when indicated, potassium removal, and dialysis for refractory disease. [19]" ], [ "Hyperphosphatemia with secondary hypocalcemia", "Calcium-phosphate deposition, AKI, tetany, seizures, and arrhythmia. [16][19]", "Restrict phosphate exposure, consider phosphate binders, treat symptomatic hypocalcemia cautiously, and use renal replacement therapy when refractory or severe. [19][21]" ], [ "Hyperuricemia", "Urate crystal and noncrystal-mediated kidney injury. [4][19][21]", "Hydration when tolerated and rapid urate lowering; rasburicase lowers existing urate. [19]" ], [ "AKI or oliguria", "Reduced clearance amplifies all TLS abnormalities and limits safe hydration. [19][21]", "Early nephrology consultation and a lower threshold for renal replacement therapy. [19][21]" ] ] } }, { "id": "urate-lowering", "eyebrow": "Pharmacology", "heading": "Choose allopurinol or rasburicase by urgency and urate burden", "intro": "Xanthine oxidase inhibition prevents new uric acid formation; urate oxidase removes uric acid already present.", "paragraphs": [ "Allopurinol and febuxostat reduce uric acid production by inhibiting xanthine oxidase but do not remove preformed uric acid. Their greatest role is prophylaxis in patients who can start therapy before substantial hyperuricemia develops. Rasburicase enzymatically converts uric acid to allantoin and can rapidly lower existing uric acid; it is preferred for high-risk patients or established TLS with hyperuricemia when no contraindication exists. [19][21]", "The supplied sources describe traditional rasburicase dosing of 0.15 to 0.20 mg/kg IV daily for up to 7 days, but they also note contemporary practice variation, including reduced-dose strategies that have not been uniformly tested in randomized trials. Follow current institutional protocol and product labeling for dosing, repeat dosing, and laboratory specimen handling. [18][21]", "Do not administer rasburicase to patients with known G6PD deficiency. Hemolytic anemia and methemoglobinemia are rare but serious adverse events related to oxidative stress from hydrogen peroxide generation. When feasible, screen patients at increased likelihood of G6PD deficiency before treatment; in life-threatening TLS, the urgency of treatment requires individualized risk-benefit assessment. [18][19]" ], "bullets": [ "If rasburicase is used, ensure local laboratory handling prevents ex vivo uric acid degradation; older guidance recommends transport of samples on ice. [18]", "Allopurinol requires renal-dose consideration in kidney impairment; the supplied evidence does not provide a current adult dosing regimen. [18]", "Avoid relying on allopurinol alone to rapidly correct established marked hyperuricemia. [18][19]", "Monitor for persistent hyperphosphatemia even when uric acid normalizes; contemporary reviews emphasize that phosphate-related nephrotoxicity may predominate after widespread rasburicase use. [17][21]" ], "subsections": [], "table": { "caption": "Urate-lowering agent selection in TLS. [18][19][21]", "columns": [ "Agent", "Clinical role", "Key limitation or safety issue" ], "rows": [ [ "Allopurinol", "Prevents formation of new uric acid; most useful as prophylaxis before major urate accumulation. [18][19]", "Does not reduce uric acid already formed; may permit xanthine accumulation; dose adjustment is needed with renal impairment. [18]" ], [ "Febuxostat", "Alternative xanthine oxidase inhibitor for urate prevention. [19]", "The supplied sources do not provide dosing or comparative selection criteria for acute TLS. [19]" ], [ "Rasburicase", "Rapidly degrades existing uric acid; favored in high-risk patients or hyperuricemic established TLS. [18][19]", "Contraindicated in known G6PD deficiency; may cause hemolysis or methemoglobinemia. [18][19]" ] ] } }, { "id": "acute-management", "eyebrow": "Established TLS", "heading": "Manage TLS as a time-sensitive multisystem emergency", "intro": "Parallel treatment of electrolyte abnormalities, kidney injury, and the cause of ongoing tumor lysis is required.", "paragraphs": [ "Admit patients with established or evolving clinical TLS for close monitoring. Treat hyperkalemia according to severity and ECG findings, restrict exogenous potassium and phosphate, manage volume carefully, and use urate-lowering therapy appropriate to urate burden and contraindications. [19][21]", "Treat symptomatic hypocalcemia, such as tetany, seizure, or arrhythmia, but avoid routine calcium replacement for asymptomatic biochemical hypocalcemia because added calcium can increase calcium-phosphate precipitation. The primary strategy is control of phosphate burden and restoration of renal clearance. [18][19]", "Renal replacement therapy indications are broadly similar to other causes of AKI but the threshold is lower in TLS because solute release can be rapid and persistent. Refractory hyperkalemia, persistent severe hyperphosphatemia, symptomatic hypocalcemia attributable to phosphate excess, oliguria or anuria, uncontrolled volume overload, severe acidosis, and uremic complications should prompt urgent nephrology-directed dialysis. [18][19][21]" ], "bullets": [ "Obtain nephrology consultation promptly for oliguria, rising creatinine, refractory phosphate elevation, or inability to safely continue hydration. [18][19]", "Use dialysis modality according to hemodynamic stability and expected solute burden; the supplied evidence notes that continuous therapies may be used in unstable patients, while ongoing rapid lysis may require repeated clearance. [18]", "Search for and correct contributors to AKI, including hypovolemia, nephrotoxins, obstruction, sepsis, and contrast exposure. [19][21]" ], "subsections": [ { "heading": "Timing of rasburicase in established TLS", "paragraphs": [ "In a 36-hospital U.S. observational target-trial emulation of 1,276 adults with established TLS, rasburicase administered within 12 hours of TLS onset was associated with lower in-hospital kidney replacement therapy or death than delayed or no early rasburicase (32.7% vs 42.0%; adjusted odds ratio, 0.67). The study also found lower 90-day mortality (adjusted odds ratio, 0.71). This is clinically important but remains observational evidence subject to residual confounding; it supports prompt therapy rather than proving causality. [4]" ], "bullets": [] } ], "table": { "caption": "Escalation triggers in established TLS. [18][19][21]", "columns": [ "Finding", "Action" ], "rows": [ [ "Potassium elevation with ECG abnormality, severe elevation, or inadequate response to temporizing therapy", "Treat as an emergency and arrange urgent renal replacement therapy when refractory. [18][19]" ], [ "Persistent hyperphosphatemia with worsening AKI or symptomatic hypocalcemia", "Restrict phosphate, consider binders, avoid routine calcium if asymptomatic, and initiate renal replacement therapy when refractory. [18][19][21]" ], [ "Oliguria or anuria, pulmonary edema, or inability to hydrate safely", "Urgent nephrology involvement and renal replacement therapy assessment. [18][19]" ], [ "Clinical deterioration after treatment begins", "Reassess for ongoing tumor lysis, infection, obstruction, medication toxicity, and alternative causes of metabolic derangement. [19][21]" ] ] } }, { "id": "special-situations", "eyebrow": "Practice considerations", "heading": "Anticipate TLS beyond classic leukemia and lymphoma", "intro": "Solid tumors and modern therapies can produce TLS when tumor burden and treatment response are substantial.", "paragraphs": [ "TLS is most common in rapidly proliferating hematologic malignancies with high tumor burden, but it also occurs in solid tumors and after targeted therapy. A reported case of lenvatinib-associated TLS in hepatocellular carcinoma illustrates that clinically important TLS can occur after noncytotoxic targeted therapy; case reports establish signal recognition, not incidence or routine prophylaxis requirements. [14][16]", "For patients receiving new therapies, determine whether the regimen label, disease-specific guideline, or institutional pathway has a mandated step-up schedule, hydration plan, laboratory schedule, or inpatient observation requirement. General TLS principles remain applicable, but the risk window and pace of lysis may differ by agent. [17][21]" ], "bullets": [ "Do not dismiss TLS because therapy is oral, targeted, immunologic, or palliative. [14][17][21]", "Reassess risk after debulking, before escalation, and whenever kidney function worsens or baseline urate rises. [19][21]" ], "subsections": [], "table": { "caption": "", "columns": [], "rows": [] } } ], "faq": [ { "question": "When should rasburicase be used instead of allopurinol?", "answer": "Use rasburicase when rapid reduction of existing uric acid is needed, particularly in high-risk patients or established hyperuricemic TLS. Allopurinol prevents new uric acid formation but does not remove urate already present. [18][19]" }, { "question": "Should urine alkalinization be used in TLS?", "answer": "No. Routine urine alkalinization is not recommended because it lacks demonstrated benefit and can promote calcium-phosphate deposition and xanthine precipitation, worsening renal injury. [18][19]" }, { "question": "What is the practical dialysis threshold in TLS?", "answer": "Use a lower threshold than in routine AKI when rapid solute release is ongoing. Refractory hyperkalemia, severe or persistent hyperphosphatemia, symptomatic hypocalcemia from phosphate excess, oliguria or anuria, uncontrolled volume overload, severe acidosis, or uremic complications warrant urgent nephrology-directed renal replacement therapy. [18][19][21]" }, { "question": "Can TLS occur spontaneously or in solid tumors?", "answer": "Yes. TLS may precede therapy in patients with high tumor burden and can occur in solid tumors or with modern targeted therapies when cellular destruction is rapid. [4][14][18][21]" } ], "references": [ { "number": 1, "title": "- IIER - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/219962Orig1s000Lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 2, "title": "Food and Drug Administration", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/204114s025lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 3, "title": "FDA Label Search-Package Code", "detail": "labels.fda.gov", "url": "https://labels.fda.gov/packagecode.cfm", "authors": "labels.fda.gov", "host": "labels.fda.gov" }, { "number": 4, "title": "Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial | The BMJ", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/394/bmj-2026-100040", "authors": "www.bmj.com", "host": "www.bmj.com" }, { "number": 5, "title": "Spontaneous tumour lysis syndrome in chronic lymphocytic ...", "detail": "casereports.bmj.com", "url": "https://casereports.bmj.com/content/17/11/e261320", "authors": "casereports.bmj.com", "host": "casereports.bmj.com" }, { "number": 6, "title": "Expert consensus guidelines on management and best practices for tumor-infiltrating lymphocyte cell therapy | Journal for ImmunoTherapy of Cancer", "detail": "jitc.bmj.com", "url": "https://jitc.bmj.com/content/12/2/e008735", "authors": "jitc.bmj.com", "host": "jitc.bmj.com" }, { "number": 7, "title": "Supplementary appendix", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/cms/10.1016/S2352-3026(21)00307-0/attachment/9cfba348-95ce-48e8-855a-ec590eaf8407/mmc1.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 8, "title": "Spontaneous Tumor Lysis Syndrome Secondary to ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/aimcc.2024.0871", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 9, "title": "Abstract 18257: Arrhythmias in Tumor Lysis Syndrome", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circ.148.suppl_1.18257", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 10, "title": "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/cir.0b013e3181d4739e", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 11, "title": "Contemporary Diagnosis and Management of Patients ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000000670", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 12, "title": "Guidelines for the Early Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/str.0b013e318284056a", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 13, "title": "FDA-approved heterocyclic molecules for cancer treatment", "detail": "www.cell.com", "url": "https://www.cell.com/heliyon/fulltext/S2405-8440(23)10380-X", "authors": "www.cell.com", "host": "www.cell.com" }, { "number": 14, "title": "Lenvatinib-Induced Tumor Lysis Syndrome in... : ACG Case Reports Journal", "detail": "journals.lww.com", "url": "https://journals.lww.com/acgcr/fulltext/2023/09000/lenvatinib_induced_tumor_lysis_syndrome_in.7.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 15, "title": "Tumor Lysis Syndrome: Pathophysiology, Risk Factors, ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/japa/_layouts/15/oaks.journals/downloadpdf.aspx?an=02276274-202307000-00003", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 16, "title": "Tumor Lysis Syndrome : Critical Care Nurse", "detail": "journals.lww.com", "url": "https://journals.lww.com/00003242-202206000-00003", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 17, "title": "Tumor Lysis Syndrome : New England Journal of Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/00006024-202509180-00008", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 18, "title": "Tumor Lysis Syndrome - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/tumor-lysis-syndrome", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 19, "title": "Tumor Lysis Syndrome", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1548559521000963", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 20, "title": "Review article Tumor lysis syndrome in gynecologic cancers", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2352578919301031", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 21, "title": "Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: Results of a modified Delphi panel", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0305737223000968", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 22, "title": "British Journal of Haematology", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.70092", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 23, "title": "British Society for Haematology Updated Guidelines for the ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjh.70092", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 24, "title": "An Unusual Presentation of Tumor Lysis Syndrome in a ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1155/2012/468452", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "- IIER - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/219962Orig1s000Lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "\"\" Net Content Statement 1118IN. SSQ,KORl.£55 1 /111, MOll:TIWI 550. 11. IIIT NOT MOIETIM 25 SQ. IN. 111GIN. MOll:TIWI 25 SQ. IN, 11/T NOTMOIET!wt 1 00&1l.K 11411. MOll:TIWI 100 SQ. IN. BUT NOT MOIETIM«ll Sil. K 1/2 II. ULN or bilirubin > 1x to 1.5x ULN and any AST) hepatic impairment. A recommended dos", "score": 0.1810752 }, { "number": 3, "title": "FDA Label Search-Package Code", "detail": "labels.fda.gov", "url": "https://labels.fda.gov/packagecode.cfm", "authors": "labels.fda.gov", "host": "labels.fda.gov", "snippet": "-\n\n-\n\n#### Links on this page:\n\nNote: If you need help accessing information in different file formats, see Instructions for Downloading Viewers and Players. \nLanguage Assistance Available: Español | 繁體中文 | Tiếng Việt | 한국어 | Tagalog | Русский | العربية | Kreyòl Ayisyen | Français | Polski | Portu", "score": 0.10140263 }, { "number": 4, "title": "Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial | The BMJ", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/394/bmj-2026-100040", "authors": "www.bmj.com", "host": "www.bmj.com", "snippet": "We included adults (≥18 years) if they had known or suspected active haematological malignancy or solid tumour with metastases; a high tumour burden, defined as white blood cell count >50×109/L or lactate dehydrogenase >3 times the upper limit of normal; laboratory features consistent with TLS, defi", "score": 0.34693998 }, { "number": 5, "title": "Spontaneous tumour lysis syndrome in chronic lymphocytic ...", "detail": "casereports.bmj.com", "url": "https://casereports.bmj.com/content/17/11/e261320", "authors": "casereports.bmj.com", "host": "casereports.bmj.com", "snippet": "by K Verma Saluja · 2024 · Cited by 2 — The inherent risk factors which predispose to tumour lysis syndrome include high tumour burden, high rate of proliferation, high sensitivity to chemotherapy and", "score": 0.22030927 }, { "number": 6, "title": "Expert consensus guidelines on management and best practices for tumor-infiltrating lymphocyte cell therapy | Journal for ImmunoTherapy of Cancer", "detail": "jitc.bmj.com", "url": "https://jitc.bmj.com/content/12/2/e008735", "authors": "jitc.bmj.com", "host": "jitc.bmj.com", "snippet": "operating procedures for chain of custody and chain of identity from operating room to shipment and pathology review of the tumor sample if needed. The surgeon conducts postoperative follow-up, and the medical oncologist and/or cell therapy team typically coordinates the next steps in care. [...] he", "score": 0.11561101 }, { "number": 7, "title": "Supplementary appendix", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/cms/10.1016/S2352-3026(21)00307-0/attachment/9cfba348-95ce-48e8-855a-ec590eaf8407/mmc1.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "The proportion of patients with high, medium, and low tumor lysis syndrome risk at screening and cycle 3 day 1 are shown. ... survival is calculated from the", "score": 0.2674687 }, { "number": 8, "title": "Spontaneous Tumor Lysis Syndrome Secondary to ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/aimcc.2024.0871", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "Tumor lysis syndrome occurs due to high degrees of cell lysis, resulting in the release of potassium, phosphate, and nucleic acids into", "score": 0.2660227 }, { "number": 9, "title": "Abstract 18257: Arrhythmias in Tumor Lysis Syndrome", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circ.148.suppl_1.18257", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Conclusion: Patients with TLS are at high risk for arrhythmias, all-cause mortality and cardiac morbidity. Preventive strategies like continuous", "score": 0.2493791 }, { "number": 10, "title": "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/cir.0b013e3181d4739e", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The reader will note that several topics or referenced areas may appear more than once throughout the guideline. This will appear to be redundant to those who choose to read the entire document, but the writing committee believed that because of the multidisciplinary nature of and organizational inv", "score": 0.19557908 }, { "number": 11, "title": "Contemporary Diagnosis and Management of Patients ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000000670", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by JE Tamis-Holland · 2019 · Cited by 1174 — Referenced in 6 clinical guideline sources · Picked up by 2 podcasts. 890 readers on Mendeley. Citations. Download Citations. If you have the", "score": 0.09322316 }, { "number": 12, "title": "Guidelines for the Early Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/str.0b013e318284056a", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by EC Jauch · 2013 · Cited by 6292 — Referenced in 18 clinical guideline sources · Picked up by 1 podcasts. 3972 readers on Mendeley. 6 readers on CiteULike. Citations. Download", "score": 0.07727375 }, { "number": 13, "title": "FDA-approved heterocyclic molecules for cancer treatment", "detail": "www.cell.com", "url": "https://www.cell.com/heliyon/fulltext/S2405-8440(23)10380-X", "authors": "www.cell.com", "host": "www.cell.com", "snippet": "by M Hossain · 2024 · Cited by 71 — These medications are used to treat cancer patients. Fatal adverse effects were sepsis, large intestine perforation, tumor lysis syndrome, pneumonia, dyspnea,", "score": 0.18608062 }, { "number": 14, "title": "Lenvatinib-Induced Tumor Lysis Syndrome in... : ACG Case Reports Journal", "detail": "journals.lww.com", "url": "https://journals.lww.com/acgcr/fulltext/2023/09000/lenvatinib_induced_tumor_lysis_syndrome_in.7.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "## REFERENCES\n\n ## 1.\n\n Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–50.\n\n Cited HereFull TextCrossRefPubMedGoogle Scholar\n ## 2", "score": 0.5614318 }, { "number": 15, "title": "Tumor Lysis Syndrome: Pathophysiology, Risk Factors, ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/japa/_layouts/15/oaks.journals/downloadpdf.aspx?an=02276274-202307000-00003", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Image 4: Creative commons license\n\nOpen\n\nAbstract\n\nTumor lysis syndrome (TLS) is an oncological emergency that occurs when cancer cells are rapidly destroyed, leading to metabolic disturbances and potentially life-threatening complications. Prompt recognition and prevention of TLS are essential to e", "score": 0.5255399 }, { "number": 16, "title": "Tumor Lysis Syndrome : Critical Care Nurse", "detail": "journals.lww.com", "url": "https://journals.lww.com/00003242-202206000-00003", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Abstract\n\n## Background\n\nTumor lysis syndrome is a life-threatening oncologic emergency in adult and pediatric patients with hematologic cancer. It occurs most often in malignancies with rapid cell turnover and large tumor burden, but its incidence has risen in solid tumors. The subsequent release o", "score": 0.49011418 }, { "number": 17, "title": "Tumor Lysis Syndrome : New England Journal of Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/00006024-202509180-00008", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Advertisement\n\nOvid® Ovid Logo\n\nSearch Ovid Search Ovid\n\nBrowse Browse\n\nLogin Login\n\nThe New England Journal of Medicine\n\nNavbar\n\nMenu\n\n Current Issue \n Previous Issues \n Latest Articles \n\n More menu items \n\nSearch Journal Search Journal\n\nButton group.\n\n Check Access \n Image 1Permi", "score": 0.38998842 }, { "number": 18, "title": "Tumor Lysis Syndrome - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/tumor-lysis-syndrome", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "prognosis is good if the patient survives the immediate complications. [...] Although the lysis of malignant cells usually begins after the institution of chemotherapy, spontaneous TLS occurs.61 Important considerations in TLS include the level of tumor burden and the sensitivity of the cells to the", "score": 0.60386235 }, { "number": 19, "title": "Tumor Lysis Syndrome", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1548559521000963", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "## Outcomes\n\nIf left untreated, TLS can have a grim prognosis. In a retrospective study of more than 700 patients with AML receiving induction chemotherapy, clinical TLS was strongly associated with a higher mortality rate than in patients without clinical TLS (79% vs 23%, _P_<0.001).24 However, pat", "score": 0.5515985 }, { "number": 20, "title": "Review article Tumor lysis syndrome in gynecologic cancers", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2352578919301031", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by T Castellano · 2019 · Cited by 5 — Cairo-Bishop criteria for diagnosis of TLS. Laboratory finding* Serum concentration Change from baseline Clinical finding** Uric acid ≥ 8 mg/dL Increase 25%", "score": 0.48381975 }, { "number": 21, "title": "Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: Results of a modified Delphi panel", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0305737223000968", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "2025, American Journal of Emergency Medicine Show abstract Tumor lysis syndrome (TLS) is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of TLS, including presentation, diagnosis, and management in the emergency departm", "score": 0.4787 }, { "number": 22, "title": "British Journal of Haematology", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.70092", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by YLT Chan · 2025 · Cited by 7 — Incidence, clinical characteristics and prognosis of tumor lysis syndrome following B-cell maturation antigen-targeted chimeric antigen", "score": 0.38428864 }, { "number": 23, "title": "British Society for Haematology Updated Guidelines for the ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjh.70092", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by YLT Chan · 2025 · Cited by 7 — updated guidelines for the diagnosis and management of tumour lysis syndrome in adults and children with haematological malignancies: tested", "score": 0.37689888 }, { "number": 24, "title": "An Unusual Presentation of Tumor Lysis Syndrome in a ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1155/2012/468452", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "As a result, patients with massive TLS who have been prescribed allopurinol may develop xanthine precipitation leading to acute renal failure [1", "score": 0.42691937 } ], "publishedAt": "2026-08-20T23:35:50.928681Z", "updatedAt": "2026-08-20T23:35:50.928681Z", "readingMinutes": 6, "slug": "tumor-lysis-syndrome" }