Maekawa t, take j, kawamura t, horiuchi t, kato s, saga r, yamamura t, watanabe j, kobayashi a, kobayashi s, sato k, kimura fdelayed onset tumor lysis syndrome after initial pomalidomide treatment in a patient with refractory multiple myeloma. Tls is characterized by a series of metabolic disorders induced by rapid tumor cell death and release of. A literature search identified published phase iiii clinical trials of monoclonal antibodies otlertuzumab, brentuximab, obinutuzumab, ibritumomab, ofatumumab. Patients with advanced stage disease andor high tumor burden should be closely monitored, appropriate precautions should be taken, and treatment should be instituted as appropriate. A patient with tumor lysis syndrome cancer network. Tumor lysis syndrome tls is an oncologic emergency that is usually seen when tumor cells undergo rapid decomposition spontaneously or, more often, in response to cytoreductive therapy with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. Tumour lysis has been documented in patients with hepatocellular carcinoma after treatment with sorafenib 16, 17 and transarterial chemoembolization. Patients at high risk for the development of tumor lysis syndrome should be. Prevention and treatment of tumor lysis syndrome depend on immediate recognition of. Triological society 2011 combined sections meeting posters. May 31, 2017 these models lack a standard definition of the tumor lysis syndrome, use different primary end points i. Keywords hypercalcemia tumor lysis syndrome lymphoma paraneoplastic syndrome introduction tumor lysis syndrome tls is an important oncologic emergency associated with bulky and rapidly growing cancers.
Tumor lysis syndrome tls is an oncologic emergency triggered by the rapid release of intracellular material from lysing malignant cells. Tls is not limited to systemic chemotherapy, which travels throughout the body to destroy cancer cells. Most common in rapidly growing hematologic malignancies, tls has been reported in virtually every cancer type. Classically, tumor lysis is associated with cytotoxic chemotherapy, including. Tumor lysis syndrome hematology jama oncology jama. Tumor lysis syndrome tls is an oncologic emergency that is caused by.
Tumor lysis syndrome tls is a potentially lifethreatening metabolic disorder characterized by an elevated uric acid level, elevated serum potassium and phosphorus levels, and a decreased calcium level. Indeed, this investigation showed that rasburicase led to the normalization of uric acid within four hours of its administration, and it was well tolerated. A case of tumor lysis syndrome following chemotherapy for. For haematological malignancies, targeted therapies, such as small molecule inhibitors and monoclonal antibodies, have a high antitumour activity, are well tolerated, and have a low incidence of associated tumour lysis syndrome. Central to its pathogenesis is the rapid accumulation of uric acid derived from the breakdown of nucleic acids, which leads to kidney failure by. Tls is characterized by a series of metabolic disorders induced by rapid tumor cell death and release of toxic cellular contents into circulation. It can occur within a few hours of treatment, but it is most often seen 4872 hours 23 days after treatment starts. Tumor lysis syndrome caused by therapeutic monoclonal. Recognizing and preventing tumor lysis syndrome ce article.
This can cause heart or kidney problems and lead to kidney failure. It is the single most common oncologic emergency and a frequent source of inpatient consultation for nephrologists 1. Tumour lysis syndrome is a complication of chemotherapy for haematological malignancies. Acute tumor lysis syndrome and treatment response in patients treated for refractory chronic lymphocytic leukemia with shortcourse, highdose cytosine arabinoside, cisplatin, and etoposide. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Jan 12, 2016 effective new treatments are now available for patients with hematologic malignancies. May 04, 2015 tumor lysis syndrome is an oncometabolic emergency resulting from rapid cell death. Tumor lysis syndrome tls refers to the constellation of deranged metabolic state, characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, andor azotemia, secondary to rapid breakdown of tumor cells. It is a life threatening emergency that typically follows administration of chemotherapy. Tumor lysis syndrome tls describes the clinical and laboratory sequelae that result from the rapid release of intracellular contents of dying cancer cells. This report describes a case of hypercalcemia in tls in a patient with diffuse large b cell lymphoma.
Tumour lysis syndrome tls is caused by the disintegration of malignant cells, usually following the instigation of chemotherapy. Tumor lysis syndrome tls in adult patients page 1 of 7. Tumor lysis syndrome tls is a potential complication characterized by hyperuricemia, hyperphosphatemia, hyperkalemia and hypocalcemia due to massive necrosis of malignant cells after cytotoxic therapy. Patients with rapidly proliferating tumor and high tumor burden are at risk of tumor lysis syndrome and these patients should be monitored closely and appropriate measures taken 5. Tumor lysis syndrome american society of nephrology. Stratify pediatric patients with cancer according to risk of. Tumor lysis syndrome tls is an oncologic emergency that is usually seen when tumor cells undergo rapid decomposition spontaneously or, more often, in response to cytoreductive therapy with the release of large amounts of potassium. Tls is an oncologic emergency caused by the rapid and massive breakdown of tumor cells, either spontaneously or after the initiation of cytoreductive therapy.
Spontaneous tumour lysis syndrome pubmed central pmc. Tumor lysis syndrome definition of tumor lysis syndrome by. Tls is an oncometabolic emergency resulting from rapid cell death. Laboratory tumour lysis syndrome ltls is defined as either a 25% change in level above or below normal, as defined above, for any two or more serum values of uric acid, potassium, phosphate and calcium within 3 d and before 7 d after the initiation of chemotherapy. These models lack a standard definition of the tumor lysis syndrome, use different primary end points i. The tumor lysis syndrome is the most common diseaserelated emergency in children and adults with hematologic cancers. Jun 01, 2018 tumor lysis syndrome usually presents within seven days of cancer treatment, and patients with preexisting renal insufficiency are at increased risk. Keywords tumor lysis syndrome, retroperitoneal sarcoma, cancer background tumor lysis syndrome tls is a medical emergency caused by massive lysis of malignant cells and release of intracellular components into the blood stream. Tumor lysis syndrome in patients with hematological malignancies. Tumor lysis syndrome can occur as a consequence of tumor targeted therapy or spontaneously.
If stevensjohnson syndrome occurs, discontinue adcetris and administer appropriate medical therapy 5. Tumor lysis syndrome tls has been reported to occur in 1% of patients with tumor stage ctcl and 2% of patients with stage iiiiv ptcl. May 15, 2012 tumour lysis has been documented in patients with hepatocellular carcinoma after treatment with sorafenib 16, 17 and transarterial chemoembolization. Tumor lysis syndrome usually presents within seven days of cancer treatment, and patients with preexisting renal insufficiency are at increased risk. Clinicians should stratify every hospitalized cancer patient and especially those receiving chemotherapy for the risk of tumor lysis syndrome. Tumor lysis syndrome tls is a constellation of metabolic. Cell lysis potential patient features supportive care bulky tumor or extensive metastases blast cell count or ldh organ infiltration by cancer cells hepatomegaly, splenomegaly bone marrow involvement renal infiltration or outflowtract obstruction cancer mass howard sc, et al. Dying cells release large amounts of potassium, phosphate, and uric acid into the blood. Tumor lysis syndrome tls is a condition in which the necrosis of large numbers of tumor cells causes the release of toxic amounts of intracellular contents into the circulation resulting in acute hyperuricemia, electrolyte abnormalities hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury aki. Tumor cytotoxicity releases intracellular contents, including nucleic acids, proteins, and electrolytes into the systemiccirculation and may lead to development of hyperuricemia, hyperphosphatemia, hy. Tumor lysis syndrome tls describes the clinical and laboratory sequelae that result from the rapid release of. Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies. Tumor lysis syndrome hematology jama oncology jama network.
Tumor lysis syndrome american academy of pediatrics. Tumor lysis syndrome is an oncologic emergency characterized by extensive destruction of tumor cells secondary to treatment which results in the release of intracellular content including uric acid, potassium, phosphorus, and calcium resulting in cardiac, renal, and nervous system toxicities 10, 15. Tumor lysis syndrome an overview sciencedirect topics. Tumor lysis syndrome tls in adult patients page 1 of 7 disclaimer.
Squamous cell carcinomas from the aerodigestive and genitourinary tracts commonly cause this. In oncology and hematology, this is a potentially fatal complication. Tumor lysis syndrome in the era of novel and targeted agents. Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off at the same time by the treatment, releasing their contents into the bloodstream. Tls can become lifethreatening if is not managed or treated. Ershler, md, director, institute for advanced studies in aging, washington, dc. Tumor lysis syndrome in the era of novel and targeted. Tumor lysis syndrome tls was first described in 1929 by bedrna and polcak in patients with chronic leukemia. When cancer cells break down quickly in the body, levels of uric acid, potassium, and phosphorus rise faster than the kidneys can remove them. Tumor lysis syndrome is a rare case that may happen rapidly or spontaneously. The doselimiting toxicity for this dosing regimen in patients with cll was tumor lysis syndrome tls and was observed in 53 of 116 patients studied on these 2 trials. Tumor lysis syndrome tls is a serious, sometimes lifethreatening oncologic emergency caused by rapid and massive cellular lysis and subsequent release of tumor cell contents and cytokines into. This article originally appeared in the march 2011 issue of clinical oncology alert.
The tumor lysis syndrome is the most common diseaserelated emergency. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. Tumor lysis syndrome symptoms, causes, guidelines and. This occurs most commonly after the treatment of lymphomas and leukemias.
Incidence of tumor lysis syndrome in children with advanced stage burkitts lymphomaleukemia before and after introduction of prophylactic use of urate. Tumor lysis syndrome background tumor lysis syndrome tls in pediatric patients is an oncologic emergency that involves complications of hematologic or solid malignancies. The clinical management of tumour lysis syndrome in. Guidelines for the management of pediatric and adult tumor. Tumor lysis syndrome is an oncometabolic emergency resulting from rapid cell death. Tumor lysis syndrome symptoms, causes, guidelines and treatment. Cairobishop definition of laboratory tumor lysis syndrome and clinical tumor lysis syndrome. Tumor destruction may be due to spontaneous or treatmentrelated causes, resulting in electrolyte and metabolic imbalances. Guidelines for the management of pediatric and adult tumor lysis syndrome. Jun 28, 2011 triological society 2011 combined sections meeting posters. A pharmacokineticpharmacodynamic model of tumor lysis.
Tumor lysis syndrome definition of tumor lysis syndrome. Tumour lysis syndrome in patients with chronic lymphocytic. Cairobishop classification of tumor lysis syndrome in adults. Tumor lysis syndrome tls is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. Tumor lysis syndrome in patients with acute myeloid leukemia. Cancer cells killed by therapy treatment may spill intracellular contents which may then accumulate faster than eliminated causing electrolyte and metabolic disturbances resulting to tumor lysis syndrome.
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