Friday, December 12, 2008

Tumor Lysis Syndrome

A Patient is presented with massive, untreated DLBCL, who experience tumor lysis syndrome after a single 2Gy fraction to a symptomatic R axillary mass.

Tumor Lysis Syndrome: An oncologic emergency caused by massive tumor cell lysis and release of large amounts of intracellular contents into the intravascular space.  Specifically results in elevation of serum Potassium, Nulcelic acids, and Phosphorous.

Uric acid can precipitate in the renal tubules, resulting in renal damage. 

Hande, et al. Am J Med 1993;94:133.  Study of high grade lymphoma treated with chemotherapy: 35-50% of patients had some increased in lab values after treatment.  Laboratory TLS was defined at a 25% increase in serum phosphate, K, or creatinine, or a decrease in calcium.  Pretreatment LDH and baseline renal function predicted for higher incidence of clinical tumor lysis syndrome.

Cairo, et al. Br J Haematol. 2004;127:3 - defined as a 25% change from normal values in creatine, calcium, phosphorus, BUN, or potasium.  Reviews multiple risk factors and treatments.

Coiffier, et al.  JCO 2008;26:2767 has a recent good review of TLS as well.

Interventions include hydration, rasiburicase (recombinant urate oxidase).  TLS may be prevention with allopurinol (inhibits the conversion of hypoxanthine and xanthine to urate).


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