Tumor Lysis Syndrome

  • Himaja Koneru
  • Anil Pattisapu
  • Paul D. BozykEmail author


Tumor lysis syndrome is an oncological emergency. The massive turnover of tumor cells leads to accumulation of electrolytes and uric acid that could lead to renal failure and cardiac arrhythmias. There are clinical and laboratory classifications of tumor lysis syndrome, and several risk stratification models have been proposed. Prevention of tumor lysis syndrome involves intravenous hydration and administration of hypouricemic agents. Rasburicase is preferred over allopurinol in high risk cases. Urinary alkalization in prevention is controversial. Treatment of tumor lysis syndrome includes intensive monitoring of renal function, fluid balance and electrolytes. Neuromuscular irritability manifesting as cardiac arrhythmias and seizures is a significant concern. Prevention of cardiac arrhythmias is done by appropriately managing hyperkalemia and hypocalcemia. Despite aggressive preventive measures, renal failure develops in some patients requiring initiation of renal replacement therapy. Pre-phase treatment with low intensity chemotherapy has been a strategy that is being used frequently in certain forms of cancer to reduce the development of tumor lysis syndrome. Certain aspects of management of tumor lysis syndrome remain controversial.


Tumor lysis syndrome Rasburicase Allopurinol Renal failure Urinary alkalization Renal replacement therapy Treatment prephase Phosphate binders Intravenous diuretics 


  1. 1.
    McBride A, Westervelt P. Recognizing and managing the expanded risk of tumor lysis syndrome in hematologic and solid malignancies. J Hematol Oncol. 2012;5:75-8722-5-75Google Scholar
  2. 2.
    Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127(1):3–11.CrossRefGoogle Scholar
  3. 3.
    Chaudhary K, Malhotra K, Sowers J, Aroor A. Uric acid – key ingredient in the recipe for cardiorenal metabolic syndrome. Cardiorenal Med. 2013;3(3):208–20.CrossRefGoogle Scholar
  4. 4.
    Han HJ, Lim MJ, Lee YJ, Lee JH, Yang IS, Taub M. Uric acid inhibits renal proximal tubule cell proliferation via at least two signaling pathways involving PKC, MAPK, cPLA2, and NF-kappaB. Am J Physiol Renal Physiol. 2007;292(1):F373–81.CrossRefGoogle Scholar
  5. 5.
    Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011;364(19):1844–54.CrossRefGoogle Scholar
  6. 6.
    Mato AR, Riccio BE, Qin L, Heitjan DF, Carroll M, Loren A, et al. A predictive model for the detection of tumor lysis syndrome during AML induction therapy. Leuk Lymphoma. 2006;47(5):877–83.CrossRefGoogle Scholar
  7. 7.
    Montesinos P, Lorenzo I, Martin G, Sanz J, Perez-Sirvent ML, Martinez D, 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.CrossRefGoogle Scholar
  8. 8.
    Truong TH, Beyene J, Hitzler J, Abla O, Maloney AM, Weitzman S, et al. Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome. Cancer. 2007;110(8):1832–9.CrossRefGoogle Scholar
  9. 9.
    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):2767–78.CrossRefGoogle Scholar
  10. 10.
    Lorigan PC, Woodings PL, Morgenstern GR, Scarffe JH. Tumour lysis syndrome, case report and review of the literature. Ann Oncol. 1996;7(6):631–6.CrossRefGoogle Scholar
  11. 11.
    Wilson FP, Berns JS. Tumor lysis syndrome: new challenges and recent advances. Adv Chronic Kidney Dis. 2014;21(1):18–26.CrossRefGoogle Scholar
  12. 12.
    van den Berg H, Reintsema AM. Renal tubular damage in rasburicase: risks of alkalinisation. Ann Oncol. 2004;15(1):175–6.CrossRefGoogle Scholar
  13. 13.
    Pui CH, Mahmoud HH, Wiley JM, Woods GM, Leverger G, Camitta B, 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.CrossRefGoogle Scholar
  14. 14.
    LaRosa C, McMullen L, Bakdash S, Ellis D, Krishnamurti L, Wu HY, et al. Acute renal failure from xanthine nephropathy during management of acute leukemia. Pediatr Nephrol. 2007;22(1):132–5.CrossRefGoogle Scholar
  15. 15.
    Pais VM Jr, Lowe G, Lallas CD, Preminger GM, Assimos DG. Xanthine urolithiasis. Urology. 2006;67(5):1084.e9–11.CrossRefGoogle Scholar
  16. 16.
    Goldman SC, Holcenberg JS, Finklestein JZ, Hutchinson R, Kreissman S, Johnson FL, 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.CrossRefGoogle Scholar
  17. 17.
    Bellinghieri G, Santoro D, Savica V. Emerging drugs for hyperphosphatemia. Expert Opin Emerg Drugs. 2007;12(3):355–65.CrossRefGoogle Scholar
  18. 18.
    Jeha S, Kantarjian H, Irwin D, Shen V, Shenoy S, Blaney S, 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):34–8.CrossRefGoogle Scholar
  19. 19.
    Conger JD, Falk SA. Intrarenal dynamics in the pathogenesis and prevention of acute urate nephropathy. J Clin Invest. 1977;59(5):786–93.CrossRefGoogle Scholar
  20. 20.
    Solomon R, Werner C, Mann D, D’Elia J, Silva P. Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994;331(21):1416–20.CrossRefGoogle Scholar
  21. 21.
    Majumdar SR, Kjellstrand CM, Tymchak WJ, Hervas-Malo M, Taylor DA, Teo KK. Forced euvolemic diuresis with mannitol and furosemide for prevention of contrast-induced nephropathy in patients with CKD undergoing coronary angiography: a randomized controlled trial. Am J Kidney Dis. 2009;54(4):602–9.CrossRefGoogle Scholar
  22. 22.
    Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med. 2010;362(14):1312–24.CrossRefGoogle Scholar
  23. 23.
    Prie D, Friedlander G. Genetic disorders of renal phosphate transport. N Engl J Med. 2010;362(25):2399–409.CrossRefGoogle Scholar
  24. 24.
    Kjellstrand CM, Cambell DC, von Hartitzsch B, Buselmeier TJ. Hyperuricemic acute renal failure. Arch Intern Med. 1974;133(3):349–59.CrossRefGoogle Scholar
  25. 25.
    McBride A, Trifilio S, Baxter N, Gregory TK, Howard SC. Manaing tumor Lysis syndrome in the era of novel Cancer therapies. J Adv Pract Oncol. 2017;8(7):705.PubMedPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care, and Sleep MedicineGeisinger HealthDanvilleUSA
  2. 2.Section of Pulmonary, Critical Care, and Sleep MedicineBeaumont HealthRoyal OakUSA

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