Tumor Lysis Syndrome (TLS) – At A Glance

Tumor Lysis Syndrome (TLS) is a collection of metabolic abnormalities that occur after initiating chemotherapy due to the rapid death of tumor cells, releasing their intracellular content into the blood stream

Incidence is unknown

Most commonly associated with haematological malignancies.

TLS is commonly associated with….

  • Acute leukaemia
  • Non Hodgkin’s lymphoma
  • Burkitt lymphoma
  • Any tumors with high LDH

Prognosis : Early recognition carries better prognosis, as interventions can prevent development of life threatening conditions


Pathophysiology Of TLS




Manifestations Of TLS

  • Manifestations occur due to metabolic derangement 
  • Usually occur 48 – 72 hours after initiation of chemotherapy
  • Time of onset – Anticipation is important 
  • Hyperkaemia (Earliest manifestations)
    • Weakness 
    • Paralysis
    • Paralytic ileus – Abdominal distension, vomiting
    • Arrhythmia
    • ECG changes
  • Hypocalcemia 
    • Vomiting
    • Perioral numbness
    • Paraesthesia
    • Seizures
    • Spasms
  • Hyperuricaemia
  • Hyperphosphataemia
  • Acute kidney injury 
    • Oligouria


Management Of TLS
  • Identify patients at risk 
  • Proper hydration before initiating chemotherapy
  • Monitoring of the patient, after initiating chemotherapy
    • For early identification
    • Prevent development of life threatening complications 
  • Dietary modification – Avoid potassium containing food
  • Treatment of complications
    • Hyperuricaemia – Allopurinol
    • Hyperkalaemia – Calcium gluconate, insulin dextrose infusion, salbutamol nebulization 
    • Hyperphosphatemia – Phosphate binders
    • Hypocalcaemia – Calcium supplementation 
    • AKI – Dialysis facilities should be available
 

* Avoid osmotic diuretics in AKI, as it can cause precipitation of uric acid in renal tubules  

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