A Focused Review of the Pathogenesis, Diagnosis, and Management of Tumor Lysis Syndrome for the Interventional Radiologist

The tumor lysis syndrome (TLS) is one of the most frequently encountered and dangerous oncologic emergencies.[1] TLS describes a constellation of laboratory and clinical findings resulting from the rapid breakdown of tumor cells releasing their intracellular contents into the systemic circulation. It occurs most commonly in hematologic malignancies at the start of antineoplastic therapy, but has also been reported in a broad variety of solid organ malignancies, as well as occurring spontaneously without chemotherapy.[2] [3] [4] [5] As a potentially fatal oncologic emergency, it is imperative to identify patients at risk for early preventative therapy, understand the pathophysiology and consequences of this syndrome, and recognize the clinical and laboratory manifestations of TLS to ensure timely and appropriate treatment.

• References

• 1 Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med 2011; 364 (19) 1844-1854
• 2 Mirrakhimov AE, Ali AM, Khan M, Barbaryan A. Tumor lysis syndrome in solid tumors: an up to date review of the literature. Rare Tumors 2014; 6 (2) 5389
• 3 Vaisban E, Braester A, Mosenzon O, Kolin M, Horn Y. Spontaneous tumor lysis syndrome in solid tumors: really a rare condition?. Am J Med Sci 2003; 325 (1) 38-40
• 4 Baeksgaard L, Sørensen JB. Acute tumor lysis syndrome in solid tumors—a case report and review of the literature. Cancer Chemother Pharmacol 2003; 51 (3) 187-192
• 5 Jasek AM, Day HJ. Acute spontaneous tumor lysis syndrome. Am J Hematol 1994; 47 (2) 129-131
• 6 Cairo MS, Coiffier B, Reiter A, Younes A ; TLS Expert Panel. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol 2010; 149 (4) 578-586
• 7 Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26 (16) 2767-2778
• 8 Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 2004; 127 (1) 3-11
• 9 Montesinos P, Lorenzo I, Martín G , et al. Tumor lysis syndrome in patients with acute myeloid leukemia: identification of risk factors and development of a predictive model. Haematologica 2008; 93 (1) 67-74
• 10 Mato AR, Riccio BE, Qin L , et al. A predictive model for the detection of tumor lysis syndrome during AML induction therapy. Leuk Lymphoma 2006; 47 (5) 877-883
• 11 Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin's lymphoma. Am J Med 1993; 94 (2) 133-139
• 12 Davidson MB, Thakkar S, Hix JK, Bhandarkar ND, Wong A, Schreiber MJ. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med 2004; 116 (8) 546-554
• 13 Sklarin NT, Markham M. Spontaneous recurrent tumor lysis syndrome in breast cancer. Am J Clin Oncol 1995; 18 (1) 71-73
• 14 Hsieh PM, Hung KC, Chen YS. Tumor lysis syndrome after transarterial chemoembolization of hepatocellular carcinoma: case reports and literature review. World J Gastroenterol 2009; 15 (37) 4726-4728
• 15 Tsai WL, Liang PC, Chen CH. Tumor lysis syndrome after transarterial chemoembolization plus portal venous embolization for hepatocellular carcinoma. J Formos Med Assoc 2012; 111 (12) 724-725
• 16 Wössmann W, Schrappe M, Meyer U, Zimmermann M, Reiter A. Incidence of tumor lysis syndrome in children with advanced stage Burkitt's lymphoma/leukemia before and after introduction of prophylactic use of urate oxidase. Ann Hematol 2003; 82 (3) 160-165
• 17 Annemans L, Moeremans K, Lamotte M , et al. Incidence, medical resource utilisation and costs of hyperuricemia and tumour lysis syndrome in patients with acute leukaemia and non-Hodgkin's lymphoma in four European countries. Leuk Lymphoma 2003; 44 (1) 77-83
• 18 Flombaum CD. Metabolic emergencies in the cancer patient. Semin Oncol 2000; 27 (3) 322-334
• 19 Boles JM, Dutel JL, Briere J , et al. Acute renal failure caused by extreme hyperphosphatemia after chemotherapy of an acute lymphoblastic leukemia. Cancer 1984; 53 (11) 2425-2429
• 20 Kanfer A, Richet G, Roland J, Chatelet F. Extreme hyperphosphataemia causing acute anuric nephrocalcinosis in lymphosarcoma. BMJ 1979; 1 (6174) 1320-1321
• 21 Shimada M, Johnson RJ, May Jr WS , et al. A novel role for uric acid in acute kidney injury associated with tumour lysis syndrome. Nephrol Dial Transplant 2009; 24 (10) 2960-2964
• 22 Greene ML, Fujimoto WY, Seegmiller JE. Urinary xanthine stones—a rare complications of allopurinol therapy. N Engl J Med 1969; 280 (8) 426-427
• 23 LaRosa C, McMullen L, Bakdash S , et al. Acute renal failure from xanthine nephropathy during management of acute leukemia. Pediatr Nephrol 2007; 22 (1) 132-135
• 24 Pais Jr VM, Lowe G, Lallas CD, Preminger GM, Assimos DG. Xanthine urolithiasis. Urology 2006; 67 (5) 1084.e9-1084.11
• 25 Conger JD, Falk SA. Intrarenal dynamics in the pathogenesis and prevention of acute urate nephropathy. J Clin Invest 1977; 59 (5) 786-793
• 26 DeConti RC, Calabresi P. Use of allopurinol for prevention and control of hyperuricemia in patients with neoplastic disease. N Engl J Med 1966; 274 (9) 481-486
• 27 Goldman SC, Holcenberg JS, Finklestein JZ , et al. A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. Blood 2001; 97 (10) 2998-3003
• 28 Pui CH, Mahmoud HH, Wiley JM , et al. Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients With leukemia or lymphoma. J Clin Oncol 2001; 19 (3) 697-704
• 29 Coiffier B, Mounier N, Bologna S , et al; Groupe d'Etude des Lymphomes de l'Adulte Trial on Rasburicase Activity in Adult Lymphoma. Efficacy and safety of rasburicase (recombinant urate oxidase) for the prevention and treatment of hyperuricemia during induction chemotherapy of aggressive non-Hodgkin's lymphoma: results of the GRAAL1 (Groupe d'Etude des Lymphomes de l'Adulte Trial on Rasburicase Activity in Adult Lymphoma) study. J Clin Oncol 2003; 21 (23) 4402-4406
• 30 Jeha S, Kantarjian H, Irwin D , et al. Efficacy and safety of rasburicase, a recombinant urate oxidase (Elitek), in the management of malignancy-associated hyperuricemia in pediatric and adult patients: final results of a multicenter compassionate use trial. Leukemia 2005; 19 (1) 34-38
• 31 Bosly A, Sonet A, Pinkerton CR , et al. Rasburicase (recombinant urate oxidase) for the management of hyperuricemia in patients with cancer: report of an international compassionate use study. Cancer 2003; 98 (5) 1048-1054
• 32 Galardy PJ, Hochberg J, Perkins SL, Harrison L, Goldman S, Cairo MS. Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B-NHL: a Children's Oncology Group Report. Br J Haematol 2013; 163 (3) 365-372
• 33 Cortes J, Moore JO, Maziarz RT , et al. Control of plasma uric acid in adults at risk for tumor Lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone—results of a multicenter phase III study. J Clin Oncol 2010; 28 (27) 4207-4213
• 34 Lopez-Olivo MA, Pratt G, Palla SL, Salahudeen A. Rasburicase in tumor lysis syndrome of the adult: a systematic review and meta-analysis. Am J Kidney Dis 2013; 62 (3) 481-492
• 35 Cheuk DK, Chiang AK, Chan GC, Ha SY. Urate oxidase for the prevention and treatment of tumour lysis syndrome in children with cancer. Cochrane Database Syst Rev 2014; 8: CD006945
• 36 Saylor PJ, Reid TR. Tumor lysis syndrome after treatment of a gastrointestinal stromal tumor with the oral tyrosine kinase inhibitor sunitinib. J Clin Oncol 2007; 25 (23) 3544-3546
• 37 Lee MH, Cheng KI, Jang RC, Hsu JH, Dai ZK, Wu JR. Tumour lysis syndrome developing during an operation. Anaesthesia 2007; 62 (1) 85-87
• 38 Stein JE, Schwenn MR, Jacir NN, Harris BH. Surgical restraint in Burkitt's lymphoma in children. J Pediatr Surg 1991; 26 (11) 1273-1275
• 39 Stovroff MC, Coran AG, Hutchinson RJ. The role of surgery in American Burkitt's lymphoma in children. J Pediatr Surg 1991; 26 (10) 1235-1238