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Haematology

Tumour Lysis Syndrome

Dr Swapnil Pawar June 23, 2023 49


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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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