Tumour lysis syndrome

Acute tumour lysis syndrome (ATLS) can be described as a group of metabolic abnormalities which include hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia and renal failure (1).

• can be due to spontaneous or treatment-mediated cell destruction (2)

The tumour lysis syndrome:

• generally occurs in patients with lymphoproliferative malignancies, most often after initiation of treatment
  
  
• pathophysiology of tumour lysis syndrome involves massive tumor cell lysis - this leads to the release of large amounts of potassium, phosphate, and uric acid
  
  
• deposition of uric acid and calcium phosphate crystals in the renal tubules may cause acute renal failure, which is often exacerbated by concomitant intravascular volume depletion. These products are normally renally excreted - therefore preexisting renal failure exacerbates the metabolic derangements of tumor lysis syndrome
  
  
• most commonly occurs after initiation of cytotoxic chemotherapy in patients with acute lymphoblastic leukemia and high-grade lymphomas like Burkitt’s lymphoma (4)

Laboratory definition of tumour lysis syndrome (5):

The presence of two of more of the following abnormalities in a patient with cancer or undergoing treatment for cancer within 3 days prior and up to 7 days after initiation of treatment.

• Uric acid ≥476 μmol/L or 25% increase from baseline
• Potassium ≥6.0 mmol/L or 25% increase from baseline
• Phosphate ≥2.1 mmol/L or 25% increase from baseline (children)/≥1.45 mmol/L or 25% increase from baseline (adults)
• Calcium ≤1.75 mmol/L or 25% decrease from baseline

Clinical definition of tumour lysis syndrome (5):

A patient with laboratory tumour lysis syndrome and at least one of:

• Creatinine ≥1.5 × ULN (age >12 years or age-adjusted)
• Cardiac arrhythmia
• Sudden death
• Seizure

Reference:

• 1. British Committee for Standards in Haematology et al.Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol. 2006;135(4):450-74.
• 2. Jabbour EJ, Estey E, Kantarjian HM. Adult acute myeloid leukemia. Mayo Clin Proc. 2006 Feb;81(2):247-60.
• 3. Davidson MB et al. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med. 2004;116(8):546-5
• 4. Puri I, Sharma D, Gunturu KS, Ahmed AA. Diagnosis and management of tumor lysis syndrome. J Community Hosp Intern Med Perspect. 2020 Jun 14;10(3):269-272
• 5. Chan YLT, El-Sharkawi D, Shah P, Chanouzas D, O’Connor D, Marks SD, et al. British Society for Haematology updated guidelines for the diagnosis and management of tumour lysis syndrome in adults and children with haematological malignancies: A focus on patient safety. Br J Haematol. 2025; 00: 1–11.