eMedicine Specialties > Pediatrics: General Medicine > Oncology

Tumor Lysis Syndrome: Follow-up

Author: Alan K Ikeda, MD, Assistant Professor, Department of Pediatrics, Division of Hematology and Oncology, David Geffen School of Medicine at UCLA; Assistant Director of Pediatric Blood and Marrow Transplantation, Mattel Children's Hospital
Coauthor(s): Kathleen Sakamoto, MD, Professor, Department of Pediatrics, Division of Hematology-Oncology and Pathology and Laboratory Medicine, Mattel Children's Hospital, David Geffen School of Medicine, University of California at Los Angeles; Koyamangalath Krishnan, MD, FRCP, FACP, Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University; Amit P Sarnaik, MD, Staff Physician, Department of Pediatrics, Wayne State University and Children's Hospital of Michigan
Contributor Information and Disclosures

Updated: Sep 26, 2008

Follow-up

Further Inpatient Care

Inpatient & Outpatient Medications

Deterrence/Prevention

  • Patients without laboratory evidence of tumor lysis syndrome (TLS) who remain at high risk should have prophylactic measures begun 24-48 hours prior to initiation of cytotoxic therapy. Prophylactic measures include liberal intravenous fluid administration, allopurinol, and urinary alkalinization. Close monitoring of fluid status and blood chemistry is important and should continue until 48-72 hours after chemotherapy initiation. Please refer to the previous section on Medical Care for more information.

Complications

  • Potential complications include uremia and oliguric renal failure due to tubule precipitation of uric acid, calcium phosphate, or hypoxanthine.
  • Severe electrolyte disturbances, such as hyperkalemia and hypocalcemia, predispose patients to cardiac arrhythmia and seizures.
  • Iatrogenic complications, such as pulmonary edema from overly vigorous hydration or metabolic alkalosis from excess exogenous administration of bicarbonate, also can occur and are life threatening if not immediately addressed.

Prognosis

  • Early recognition of signs and symptoms of patients at risk for tumor lysis syndrome, including identification of abnormal clinical and laboratory values, can lead to successful prevention of the otherwise life-threatening complications of tumor lysis syndrome.
 


More on Tumor Lysis Syndrome

Overview: Tumor Lysis Syndrome
Differential Diagnoses & Workup: Tumor Lysis Syndrome
Treatment & Medication: Tumor Lysis Syndrome
Follow-up: Tumor Lysis Syndrome
References
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References

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  2. Cohen LF, Balow JE, Magrath IT, Poplack DG, Ziegler JL. Acute tumor lysis syndrome. A review of 37 patients with Burkitt's lymphoma. Am J Med. Apr 1980;68(4):486-91. [Medline].

  3. Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin's lymphoma. Am J Med. Feb 1993;94(2):133-9. [Medline].

  4. Kizer N, Martinez E, Powell M. Report of two cases of rasburicase-induced methemoglobinemia. Leuk Lymphoma. Dec 2006;47(12):2648-50. [Medline].

  5. Bessmertny O, Robtaille LM, Cairo MS. Rasburicase: a new approach for preventing and/or treating tunor lysis syndrome. Curr Pharm Des. Jan 2005;11(32):4177-85. [Medline].

  6. Goldman SC. Rasburicase: potential role in managing tumor lysis in patients with hematological malignancies. Expert Rev Anticancer Ther. Aug 2003;3(4):429-33. [Medline].

  7. Jeha S, Pui CH. Recombinant urate oxidase (rasburicase) in the prophylaxis and treatment of tumor lysis syndrome. Contrib Nephrol. Jan 2005;147:69-79. [Medline].

  8. Yim BT, Sims-McCallum RP, Chong PH. Rasburicase for the treatment and prevention of hyperuricemia. Ann Pharmacother. Jul-Aug 2003;37(7-8):1047-54. [Medline].

  9. Andreoli SP, Clark JH, McGuire WA. Purine excretion during tumor lysis in children with acute lymphocytic leukemia receiving allopurinol: relationship to acute renal failure. J Pediatr. Aug 1986;109(2):292-8. [Medline].

  10. Abdullah S, Diezi M, Sung L, Dupuis LL, Geary D, Abla O. Sevelamer hydrochloride: A novel treatment of hyperphosphatemia associated with tumor lysis syndrome in children. Pediatric Blood Cancer. January 2008;Epub:[Medline].

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  12. Arrowsmith ER, Greer JP, Macon WR. Complications of hematopoietic neoplasms. In: Wintrobe's Clinical Hematology. 1999:2052-5.

  13. Bishop MR, Coccia PF. Tumor lysis syndrome. In: Abeloff, ed. Clinical Oncology. 2000:750-3.

  14. Davidson MB, Thakkar S, Hix JK, et al. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med. Apr 15 2004;116(8):546-54. [Medline].

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  29. 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. Oct 15 2007;110(8):1832-9. [Medline].

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Further Reading

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Keywords

tumor lysis syndrome, TLS, acute tumor lysis syndrome, ATLS, hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, acute renal failure, ARF, Burkitt lymphoma, T-cell acute lymphoblastic leukemia, hepatoblastoma, neuroblastoma, obstructive uropathy, pericarditis, uremia, renal colic, arthralgia, arthritis, hypertension

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Contributor Information and Disclosures

Author

Alan K Ikeda, MD, Assistant Professor, Department of Pediatrics, Division of Hematology and Oncology, David Geffen School of Medicine at UCLA; Assistant Director of Pediatric Blood and Marrow Transplantation, Mattel Children's Hospital
Alan K Ikeda, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Blood and Marrow Transplantation, and American Society of Pediatric Hematology/Oncology
Disclosure: emedicine Honoraria author

Coauthor(s)

Kathleen Sakamoto, MD, Professor, Department of Pediatrics, Division of Hematology-Oncology and Pathology and Laboratory Medicine, Mattel Children's Hospital, David Geffen School of Medicine, University of California at Los Angeles
Kathleen Sakamoto, MD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, Society for Pediatric Research, and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

Koyamangalath Krishnan, MD, FRCP, FACP, Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians
Disclosure: Nothing to disclose.

Amit P Sarnaik, MD, Staff Physician, Department of Pediatrics, Wayne State University and Children's Hospital of Michigan
Amit P Sarnaik, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Stephan A Grupp, MD, PhD, Director, Stem Cell Biology Program, Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania
Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Steven K Bergstrom, MD, Assistant to the Chairman, Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland
Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology
Disclosure: Nothing to disclose.

CME Editor

Helen SL Chan, MBBS, FRCP(C), FAAP, Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA, Executive Director, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC; Professor of Medicine, Oncology, and Pediatrics, Georgetown University
Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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