Tumor lysis Syndrome

1. FEBUDAY
Tumor Lysis Syndrome

2. TUMOR LYSIS SYNDROME
Tumor lysis syndrome (TLS) is
characterized by an array of metabolic
imbalances associated with the rapid
destruction of a large number of WBCs.
that develop inpatients with cancer after the
onset of chemotherapy treatment or, less
often, prior to treatment.
Contd
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3. TUMOR LYSIS SYNDROME
TLS has been reported most often in patients
Suffering from malignancies with a high rate of
proliferation, especially cancers with a high response rate
and rapid responses to cytotoxic therapy.
Contd
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4. TUMOR LYSIS SYNDROME
These include aggressive non-Hodgkin lymphoma, notably
diffuse large B-cell lymphoma, lymphoblastic lymphoma,
and Burkett lymphoma; acute and chronic leukaemia's ;
and, less often, bulky solid tumors.

5. TIMING
Occurs 24-48 hours into treatment
May persist up to one week

6. CAUSES of TLS
• Following the administration of therapy, malignant cells
are destroyed rapidly releasing into circulation intracellular
components.

7. Risk Factors
• high tumor burden
• high rate of proliferation
• and disease that is highly responsive to therapy
• Bulky tumors ( > 8-10cm)

8. Other Risk Factors
• Pre-existing Hyperuricemia
• ≥ 60 years old

9. Spontaneous TLS
• Release of purine metabolites that result in metabolic
abnormalities
• > Highly proliferative, poorly differentiated malignancies
• - Burkett's lymphoma/ leukemia - Acute lymphoblastic
lymphoma/ leukemia

10. Treatment Induced TLS
• Chemotherapy/Biotherapy
• Radiation therapy
• Corticosteroids

11. Spontaneous vs Treatment Induced
• Usually no elevation in phosphorous in spontaneous
tumor lysis syndrome
• Postulated: rapid proliferation rates of tumor cells can
increase uric acid levels through rapid nucleoprotein
turnover
• Tumor then utilizes released phosphorus for synthesis of
new tumor cells

12. Characteristic Abnormalities Associated
With Tumor Lysis Syndrome
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Followed by
IMPAIRMENTOF KIDNEYFUNCTION

13. HYPERURICEMIA
• Hyperuricemia is an excess of uric acid in the blood.
• NORMAL LEVEL
• 2.4-6.0 mg/dL (female)
• 3.4-7.0 mg/dL (male)

14. HYPERURICEMIA
• Nausea/vomiting/Diarrhea
• Anuria
• Oliguria
• Flank pain
• Cloudy urine
• Uric acid crystalluria
• Renal Obstruction
• Acute Renal Failure

15. PATHOPHYSIOLOGY
RISK FACTORS:
• High tumor burden
• High rate of proliferation
• Disease that is highly responsive to therapy
• Bulky tumors ( > 8-10cm)
• Pre-existing Hyperuricemia
• ≥ 60 years old
Leading to TUMOR RESPONDS RAPIDLY
Causing DESTRUCTION OF A LARGE NUMBER OF MALIGNANT CELLS

16. Uric Acid Nephropathy
Direct result of ↑ UA crystals forming in renal tubules
and distal collecting system
When associated with TLS it is more likely to see
oliguria(<100 ml/d) or anuria
In this patient, normalization of PO4 is necessary for
quick recovery of renal function