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In a malignancy with a high proliferative rate, large tumor burden, or high sensitivity to treatment, initiation of chemotherapy and/or radiation therapy can induce rapid lysis of tumor cells resulting in tumor lysis syndrome (TLS; Larson & Pui, 2012a).
How does chemotherapy cause tumor lysis syndrome?
The people most at risk for developing tumor lysis syndrome are those with blood cancers, especially acute lymphoblastic leukemia and high-grade lymphomas (such as Burkitt lymphoma ). However, TLS can also occur, albeit rarely, in patients with solid tumors such as lung or breast cancer.
Who is at risk for tumor lysis syndrome (TLS)?
Tumor lysis syndrome occurs quickly and can rapidly become a medical emergency. Healthcare providers treat tumor lysis syndrome with medication and intravenous hydration. But healthcare providers can prevent tumor lysis syndrome. They do this by knowing who may be at increased risk and using preventive measures to reduce that risk.
Can tumor lysis syndrome be prevented?
The Cairo-Bishop grading system for TLS (see Table 2) includes definitions of TLS, LTLS, and CTLS and the clinical manifestations (renal, neurologic, and cardiac) that dictate the grade of TLS (Cairo & Bishop, 2004). Open in a separate window Table 2 Table 2.Cairo-Bishop Grading Classification of Tumor Lysis Syndrome
What is the Cairo-Bishop grading system for tumor lysis syndrome (TLS)?
What is the cause of tumor lysis syndrome?
Tumor lysis syndrome is caused by the massive release of intracellular ions such as potassium, phosphorus, and nucleic acids that have been metabolized to uric acid. The main organ responsible for the excretions of these substances is the kidney.
Which of the following is a key strategy in the prevention of tumor lysis syndrome?
The most important treatment modality in the prevention of TLS is hyperhydration with IV fluids beginning prior to chemotherapy in high-risk patients (Coiffier et al., 2008). Fluid administration increases renal tubular flow and promotes the elimination of urates and phosphates (Coiffier et al., 2008).
What chemo drugs cause tumor lysis syndrome?
Agents reported to cause tumor lysis syndrome include the following:Paclitaxel.Fludarabine.Etoposide.Thalidomide.Bortezomib.Zoledronic acid.Hydroxyurea.Carfilzomib.More items...
Which drug would be most likely to cause Tumour lysis syndrome?
Agents reported to cause tumor lysis syndrome include the following: Paclitaxel. Fludarabine. Etoposide.
What is tumor lysis syndrome treatment?
In general, treatment of TLS consists of intensive hydration, stimulation of diuresis, and, more specifically, in the use of allopurinol and rasburicase.
What is the risk of tumor lysis syndrome?
The factors that increase risk of tumor lysis syndrome include elevated LDH, extensive bone marrow involvement, pre-existing renal disease and reduced urinary output, advance age, and the use of drugs that increase serum uric acid such as alcohol, thiazide diuretics, levodopa.
Who is at the highest risk for developing tumor lysis syndrome?
Patients with a large “tumor burden” of cancer cells and/or tumors that typically have rapidly dividing cells, such as acute leukemia or high-grade lymphoma, as well as tumors that are highly responsive to therapy, are at greatest risk of developing TLS.
Does chemo cause tumor lysis?
Tumour lysis syndrome usually occurs at the start of chemotherapy when a large number of tumour cells are destroyed. It can occur within a few hours of treatment, but it is most often seen 48–72 hours (2–3 days) after treatment starts.
Does radiation cause tumor lysis syndrome?
Tumor lysis syndrome (TLS) is an important oncological emergency that is usually observed with hematological malignancies and rarely with solid tumors. It can be induced either by therapy or spontaneously. Radiotherapy-induced TLS has been rarely reported in the literature.
How does allopurinol prevent tumor lysis syndrome?
Medications can be adjusted after the start of chemotherapy in response to the level of tumor lysis and/or metabolic disturbances. Allopurinol, a xanthine oxidase inhibitor, reduces the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure.
How does allopurinol prevent TLS?
Once renal failure develops, renal function usually is not restored until uric acid levels are brought down to less than 10 mg/dL. Allopurinol. Allopurinol is a key agent in the management of TLS. Allopurinol acts by competitively inhibiting xanthine oxidase, thereby preventing the conversion of xanthine to uric acid.
What is tumor lysis syndrome?
Tumor lysis syndrome (TLS) occurs when a massive number of cancer cells die and release various electrolytes, proteins, and acids into a patient's bloodstream. The massive and sudden cell death most commonly occurs after a person with blood cancer (usually acute leukemia or an aggressive lymphoma, ...
What is the drug called that reduces phosphorus absorption?
High phosphate levels: Drugs called oral phosphate binders—such as PhosLo (calcium acetate)—are taken with meals to reduce the absorption of phosphorus into the gut. High uric acid levels: A drug called Elitek (rasburicase), which triggers the degradation of uric acid in the body, is often given. 7 .
What happens when cancer cells die suddenly?
Tumor lysis syndrome can develop when there is a large number of cancer cells that die suddenly. As tumor cells "lyse" or die and rapidly break open, their spilled contents—potassium, phosphate, and uric acid—are released in large amounts into the patient's bloodstream. 1
What happens when a tumor dies?
In addition to electrolytes and acids, the death of tumor cells can lead to the release of proteins called cytokines. These cytokines may trigger a whole-body inflammatory response which can ultimately lead to multi-organ failure. 3 .
Can TLS be caused by cancer?
Research has found that more than 1 in 4 children with acute lymphoblastic leukemia will develop TLS after undergoing cancer treatment. 2 . In general, there are tumor-specific factors that increase a person's risk of developing TLS. These factors include: Tumors that are particularly sensitive to chemotherapy.
Can TLS occur spontaneously?
While TLS most commonly develops after a patient receives chemotherapy, it can rarely occur spontaneously. This means that the cancer cells break open and spill their contents on their own, before even being exposed to one or more cancer drugs.
Is tumor lysis syndrome a cancer?
Tumor lysis syndrome is considered a cancer emergency because it is potentially fatal if not recognized and treated promptly. The good news is that most people who undergo chemotherapy do not develop TLS, and for those at an increased risk, doctors can be proactive and implement preventive strategies to minimize those chances.
How long does it take for tumor lysis to occur?
Most often occurring 48–72 hours ...
What happens when cancer cells are lysed?
As the kidneys struggle to keep up with the excretion of the lysed cell contents , hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia can quickly develop.
What is the most dangerous serum imbalance caused by TLS?
Google Scholar. Hyperkalemia is the most dangerous serum imbalance caused by TLS, as it can cause sudden death from cardiac dysrhythmia. Serum potassium is measured frequently, and patients are encouraged to limit potassium and phosphorus intake during their individual risk period for TLS. 19.
What is the most common complication of TLS?
Hyperuricemia, the most common complication of TLS, is caused by the release of tumor cell proteins and nucleic acids. Followed by their enzymatic breakdown via xanthine oxidase to xanthine, lysed tumor cell proteins and nucleic acids are converted to their end product uric acid. 3. Haematologica. 2008; 93: 9-13.
What are the risk factors for TLS?
Malignancies most frequently associated with TLS have similar characteristics, including high sensitivity to cytotoxic therapy, large tumor burden, and high proliferation rate.
What is TLS in cancer?
Tumor lysis syndrome (TLS), a potential complication of cancer treatment, occurs when malignant cells quickly lyse, or break open, and the internal contents of the cell spill out into the bloodstream, causing metabolic abnormalities. Most often occurring 48–72 hours after the initiation of cancer treatment for hematologic malignancies, ...
When does TLS occur?
Most often occurring 48–72 hours after the initiation of cancer treatment for hematologic malignancies , TLS may present before cancer therapy and occur with other tumor types, such as breast cancer, small cell lung cancer, and neuroblastoma. 1. J Clin Oncol. 2008; 26: 2767-2778.