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)

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
• 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