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Tumour Lysis Syndrome
Dr Swapnil Pawar
Tumour Lysis Syndrome
Written by – Dr Andrew Lam
Cairo-Bishop Definition of TLS
Laboratory Diagnosis
- K > 6mmol/L and >25% increase than baseline serum level
- PO4 > 1.45mmol/L and >25% increase than baseline serum level
- Ca < 1.75mmol/L and >25% decrease than baseline serum level
- Uric Acid > 476micromol/L and >25% increase than baseline serum level
At least 2 of the above criteria must be satisfied within 3 days before or seven days after cytotoxic therapy
Clinical Diagnosis
Laboratory diagnosis PLUS one of the following:
- Increased serum creatinine > 1.5 times the upper limit of normal
- Cardiac arrhythmia or sudden death
- Seizure
Severity of TLS
| 0 | 1 | 2 | 3 | 4 | 5 | |
| Creatinine | < 1.5 x ULN | 1.5 x ULN | > 1.5 – 3 x ULN | > 3 – 6 x ULN | > 6 x ULN | Death |
| Arrhythmia | None | Nil intervention required | Non-Urgent Medical Intervention necessary | Symptomatic, requiring device for complete control | Life-Threatening | Death |
| Seizure | None | N/A | Single brief seizure or well-controlled with anti-epileptics | Poorly controlled seizures | Prolonged or repeated seizures (i.e. status epilepticus) | Death |
TLS Prophylaxis by Risk Stratification
| Low Risk | Intermediate Risk | High Risk | |
| Hydration | Aggressive hydration with 2-3L/m2 daily | Aggressive hydration with 2-3L/m2 daily | Aggressive hydration with 2-3L/m2 daily |
| Urate Lowering Therapy | N/A | Allopurinol | Rasburicase |
If established tumour lysis syndrome is present, rasburicase is the first line of treatment if not already given. Alternatives can also include allopurinol or febuxostat if rasburicase is contraindicated or unavailable.
For those with severe renal failure, dialysis may be indicated.
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