Tumour Lysis Syndrome

This section describes diagnosis and initial management of tumour lysis syndrome (TLS).

Introduction

TLS is a potentially fatal syndrome characterised by a group of metabolic derangements caused by the release of cellular components into the blood after rapid lysis of malignant cells. This is seen most often at the initial treatment of a number of high grade malignant haematological disorders and results from the instigation of treatment. However, in a small number of cases, patients can present with TLS prior to initiation of any chemotherapy. Patients at highest risk of TLS include those with high cell-count leukaemias, lymphoblastic lymphoma, bulky diffuse large B cell and Burkitt lymphoma, but less commonly, some non-haematological malignancies may present with TLS e.g. germ cell tumours or small cell lung cancer. Patients with TLS often have a high lactate dehydrogenase (LDH) level.

Features of Tumour Lysis Syndrome

Seek urgent Haematology review for patients presenting with clinical and/or laboratory features of TLS.

Clinical features of TLS reflect associated metabolic abnormalities

Acute oliguria and renal failure
Cardiac rhythm disturbance
Confusion and seizures
Nausea and vomiting
Muscle cramps and tetany

Laboratory features of TLS
Hyperuricaemia Hyperkalaemia Uraemia Hypocalcaemia Hyperphosphataemia
N.B. Spontaneous TLS prior to the initiation of any chemotherapy is associated with hyperuricaemia but frequently not with hyperphosphataemia.

Management

See the West of Scotland Cancer Network (WoSCAN) guideline on the Prophylaxis and Management of Tumour Lysis Syndrome in Adults which provides information on the definition of TLS, risk factors, assessment and treatment. The guideline is accessible via the WoSCAN intranet site (NHS network access required) / Guidelines and Protocols section / Supportive Care subsection.

The electrolyte disturbance section of the handbook provides dosing advice but should only be referred to once Haematology advice has been obtained. Treatment of established TLS should be only under the supervision of a haematologist (see Appendix 6 for contact details).

Note: Send U&Es, urate and bone profile 4-6 hours post chemotherapy, and daily in high risk patients. Urate taken whilst on rasburicase should reach the lab within 30 minutes and be interpreted with caution.

Guideline reviewed and content updated August 2020