tumor lysis syndrome


Summary: A syndrome resulting from cytotoxic therapy, occurring generally in aggressive, rapidly proliferating lymphoproliferative disorders. It is characterized by combinations of hyperuricemia, lactic acidosis, hyperkalemia, hyperphosphatemia and hypocalcemia.

Top Publications

  1. Moreau D. Pharmacological treatment of acute renal failure in intensive care unit patients. Contrib Nephrol. 2005;147:161-73 pubmed
    ..nevertheless, hematological, when patients with large tumor burden and rapid cell turnover develop acute tumor lysis syndrome (ATLS)...
  2. Rampello E, Fricia T, Malaguarnera M. The management of tumor lysis syndrome. Nat Clin Pract Oncol. 2006;3:438-47 pubmed
    The manifestation of tumor lysis syndrome (TLS) occurs when the destruction of tumor cells releases breakdown products that overwhelm the excretory mechanisms of the body. A cardinal sign is hyperuricemia, leading to uric acid nephropathy...
  3. Ajzensztejn D, Hegde V, Lee S. Tumor lysis syndrome after treatment with docetaxel for non-small-cell lung cancer. J Clin Oncol. 2006;24:2389-91 pubmed
  4. Oztop I, Demirkan B, Yaren A, Tarhan O, Sengul B, Ulukus C, et al. Rapid tumor lysis syndrome in a patient with metastatic colon cancer as a complication of treatment with 5-fluorouracil/leucoverin and irinotecan. Tumori. 2004;90:514-6 pubmed
    b>Tumor lysis syndrome is a potentially fatal complication of anti-cancer therapy that is usually seen in patients with bulky, rapidly proliferating, treatment-sensitive tumors such as hematological malignancies, but it rarely occurs in a ..
  5. Reeves D, Bestul D. Evaluation of a single fixed dose of rasburicase 7.5 mg for the treatment of hyperuricemia in adults with cancer. Pharmacotherapy. 2008;28:685-90 pubmed publisher
    ..15 mg/kg for the prevention or treatment of hyperuricemia associated with tumor lysis syndrome. Prospective, open-label study using a historical control group...
  6. Patte C, Sakiroglu O, Sommelet D. European experience in the treatment of hyperuricemia. Semin Hematol. 2001;38:9-12 pubmed
    ..management of non-Hodgkin's lymphoma (NHL) and acute lymphoblastic leukemia (ALL), and for prevention of tumor lysis syndrome (TLS)...
  7. Coiffier B, Altman A, Pui C, Younes A, Cairo M. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26:2767-78 pubmed publisher
    b>Tumor lysis syndrome (TLS) has recently been subclassified into either laboratory TLS or clinical TLS, and a grading system has been established...
  8. Davidson M, Thakkar S, Hix J, Bhandarkar N, Wong A, Schreiber M. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med. 2004;116:546-54 pubmed
    b>Tumor lysis syndrome is an oncologic emergency that is characterized by severe electrolyte abnormalities and, frequently, by acute renal failure...
  9. Tosi P, Barosi G, Lazzaro C, Liso V, Marchetti M, Morra E, et al. Consensus conference on the management of tumor lysis syndrome. Haematologica. 2008;93:1877-85 pubmed publisher
    b>Tumor lysis syndrome is a potentially life threatening complication of massive cellular lysis in cancers. Identification of high-risk patients and early recognition of the syndrome is crucial in the institution of appropriate treatments...

More Information


  1. Barquero Romero J, Catalina Fernandez I, Hernández Sáez C, Jiménez Morales J, García de la Llana F. [Spontaneous tumor lysis syndrome in a patient with non-Hodgkin's lymphoma]. An Med Interna. 2005;22:387-9 pubmed
    ..The cytology and molecular studies of cervical adenopathy sample were diagnostic of high-grade non-Hodgkin's lymphoma. A presumptive diagnosis of non Hodgkin lymphoma with spontaneous tumor lysis syndrome was made.
  2. Jaing T, Hsueh C, Tain Y, Hung I, Hsia S, Kao C. Tumor lysis syndrome in an infant with Langerhans cell histiocytosis successfully treated using continuous arteriovenous hemofiltration. J Pediatr Hematol Oncol. 2001;23:142-4 pubmed
    Langerhans cell histiocytosis (LCH) is an enigmatic disease usually occurring in children. Tumor lysis syndrome (TLS) is a clinical syndrome associated with severe metabolic derangement and oliguric acute renal failure...
  3. Cammalleri L, Malaguarnera M. Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci. 2007;4:83-93 pubmed
    ..A rapid and massive raise of uric acid, during tumor lysis syndrome (TLS), and also a lower and chronic hyperuricemia, as in gout, mainly damage the kidney...
  4. Bosly A, Sonet A, Pinkerton C, McCowage G, Bron D, Sanz M, et al. Rasburicase (recombinant urate oxidase) for the management of hyperuricemia in patients with cancer: report of an international compassionate use study. Cancer. 2003;98:1048-54 pubmed
    Hyperuricemia and tumor lysis syndrome (TLS) are serious complications that can occur during chemotherapy for hematologic malignancies, even if standard management procedures, including administration of allopurinol, are undertaken...
  5. Coiffier B, Mounier N, Bologna S, Ferme C, Tilly H, Sonet A, et al. 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. J Clin Oncol. 2003;21:4402-6 pubmed
    Hyperuricemia and tumor lysis syndrome are well-known complications during induction treatment of aggressive non-Hodgkin's lymphomas (NHLs)...
  6. Schuman S, Pearson J, Lucci J, Twiggs L. Metastatic gestational trophoblastic neoplasia complicated by tumor lysis syndrome, heart failure, and thyrotoxicosis: a case report. J Reprod Med. 2010;55:441-4 pubmed
    b>Tumor lysis syndrome (TLS) is an extremely rare complication of solid tumors and is more frequently observed in patients with hematologic malignancies...
  7. Lin T, Ruppert A, Johnson A, Fischer B, Heerema N, Andritsos L, et al. Phase II study of flavopiridol in relapsed chronic lymphocytic leukemia demonstrating high response rates in genetically high-risk disease. J Clin Oncol. 2009;27:6012-8 pubmed publisher
    ..Dose escalation did not occur in four patients, as a result of severe tumor lysis syndrome; three of these patients required hemodialysis...
  8. Joshita S, Yoshizawa K, Sano K, Kobayashi S, Sekiguchi T, Morita S, et al. A patient with advanced hepatocellular carcinoma treated with sorafenib tosylate showed massive tumor lysis with avoidance of tumor lysis syndrome. Intern Med. 2010;49:991-4 pubmed
    ..In conclusion, clinicians should bear in mind not only the published adverse effects, but also massive tumor lysis, when treating patients with large tumor burden by sorafenib. ..
  9. Pui C. Urate oxidase in the prophylaxis or treatment of hyperuricemia: the United States experience. Semin Hematol. 2001;38:13-21 pubmed
    ..These data suggest that recombinant urate oxidase is safe and effective in the prophylaxis and treatment of hyperuricemia associated with malignancy or chemotherapy. ..
  10. Phelps M, Lin T, Johnson A, Hurh E, Rozewski D, Farley K, et al. Clinical response and pharmacokinetics from a phase 1 study of an active dosing schedule of flavopiridol in relapsed chronic lymphocytic leukemia. Blood. 2009;113:2637-45 pubmed publisher
    ..with clinical response and cytokine release syndrome, and glucuronide metabolite AUC correlated with tumor lysis syndrome. These composite results confirm high activity of this pharmacokinetically derived schedule in relapsed, ..
  11. Nakamura Y, Nakamura Y, Hori E, Furuta J, Ishii Y, Takahashi T, et al. Tumor lysis syndrome after transcatheter arterial infusion of cisplatin and embolization therapy for liver metastases of melanoma. Int J Dermatol. 2009;48:763-7 pubmed publisher
    b>Tumor lysis syndrome (TLS) is rare in the treatment of solid tumors, but it may occur in myelolymphoproliferative diseases...
  12. Vora A, Bhutani M, Sharma A, Raina V. Severe tumor lysis syndrome during treatment with STI 571 in a patient with chronic myelogenous leukemia accelerated phase. Ann Oncol. 2002;13:1833-4 pubmed
  13. Mato A, Riccio B, Qin L, Heitjan D, Carroll M, Loren A, et al. A predictive model for the detection of tumor lysis syndrome during AML induction therapy. Leuk Lymphoma. 2006;47:877-83 pubmed
    b>Tumor lysis syndrome (TLS) is defined by metabolic derangements occurring in the setting of rapid tumor destruction...
  14. Cortes J, Moore J, Maziarz R, Wetzler M, Craig M, Matous J, 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;28:4207-13 pubmed publisher
    ..Adults with hematologic malignancies at risk for hyperuricemia and tumor lysis syndrome (TLS) were randomly assigned to rasburicase (0...
  15. Choi K, Lee J, Kim Y, Kim D, Kim K, Ko Y, et al. Efficacy of continuous venovenous hemofiltration with chemotherapy in patients with Burkitt lymphoma and leukemia at high risk of tumor lysis syndrome. Ann Hematol. 2009;88:639-45 pubmed publisher
    b>Tumor lysis syndrome (TLS) is a potentially fatal metabolic complication of chemotherapy for Burkitt lymphoma...
  16. Campara M, Shord S, Haaf C. Single-dose rasburicase for tumour lysis syndrome in adults: weight-based approach. J Clin Pharm Ther. 2009;34:207-13 pubmed publisher
    ..From our experience, a single dose of 0.15 mg/kg (IBW or aBW) of rasburicase appears to effectively decrease and maintain urate levels within normal limits for 48 h. ..
  17. Leibowitz A, Adamsky C, Gabrilove J, Labow D. Intraoperative acute tumor lysis syndrome during laparoscopic splenectomy preceded by splenic artery embolization. Surg Laparosc Endosc Percutan Tech. 2007;17:210-1 pubmed
    ..The patient recovered fully after suffering acute renal failure requiring dialysis for 6 weeks postoperatively. Caution using this approach is necessary to avoid this rare and potentially lethal complication...
  18. Coiffier B, Riouffol C. Management of tumor lysis syndrome in adults. Expert Rev Anticancer Ther. 2007;7:233-9 pubmed
    Spontaneous or treatment-induced tumor lysis syndrome (TLS) can cause significant morbidity and potential mortality...
  19. McDonnell A, Lenz K, Frei Lahr D, Hayslip J, Hall P. Single-dose rasburicase 6 mg in the management of tumor lysis syndrome in adults. Pharmacotherapy. 2006;26:806-12 pubmed
    ..once/day for 5 days in pediatric patients with cancer to lower plasma uric acid concentrations and manage tumor lysis syndrome (TLS)...
  20. Woo I, Kim J, Park M, Lee M, Cheon R, Chang H, et al. Spontaneous acute tumor lysis syndrome with advanced gastric cancer. J Korean Med Sci. 2001;16:115-8 pubmed
    Acute tumor lysis syndrome (TLS) occurs frequently in hematologic malignancies such as high-grade lymphomas and acute leukemia, which are rapidly proliferating and chemosensitive tumors...
  21. Treuting P, Albertson T, Preston B. Case series: acute tumor lysis syndrome in mutator mice with disseminated lymphoblastic lymphoma. Toxicol Pathol. 2010;38:476-85 pubmed publisher
    Acute tumor lysis syndrome (ATLS) is characterized by severe metabolic abnormalities and organ dysfunction resulting from rapid destruction of neoplastic cells...
  22. Busam K, Wolchok J, Jungbluth A, Chapman P. Diffuse melanosis after chemotherapy-induced tumor lysis syndrome in a patient with metastatic melanoma. J Cutan Pathol. 2004;31:274-80 pubmed
    ..is presented, who developed slate bluish-gray to brown discoloration of her skin after chemotherapy-induced tumor lysis syndrome. A number of studies were performed to re-evaluate possible mechanisms of melanosis...
  23. Krishnan G, D Silva K, Al Janadi A. Cetuximab-related tumor lysis syndrome in metastatic colon carcinoma. J Clin Oncol. 2008;26:2406-8 pubmed publisher
  24. Rianthavorn P, Cain J, Turman M. Use of conivaptan to allow aggressive hydration to prevent tumor lysis syndrome in a pediatric patient with large-cell lymphoma and SIADH. Pediatr Nephrol. 2008;23:1367-70 pubmed publisher
    ..It proved to be an important component in preventing uric acid nephropathy/tumor lysis syndrome. Conivaptan induced free-water clearance as indicated by increased urine output and decreased urine ..
  25. 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;82:160-5 pubmed
    ..urate oxidase in children with non-Hodgkin's lymphoma (NHL), we analyzed the incidence and complications of tumor lysis syndrome (TLS) in children with B-cell acute lymphoblastic leukemia (B-ALL) or stage III/IV Burkitt's lymphoma and a ..
  26. Hochberg J, Cairo M. Tumor lysis syndrome: current perspective. Haematologica. 2008;93:9-13 pubmed publisher
  27. Abe Y, Mizuno K, Horie H, Mizutani K, Okimoto Y. Transient abnormal myelopoiesis complicated by tumor lysis syndrome. Pediatr Int. 2006;48:489-92 pubmed
  28. Goldman S, Holcenberg J, Finklestein J, Hutchinson R, Kreissman S, Johnson F, et al. A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. Blood. 2001;97:2998-3003 pubmed
    ..For pediatric patients with advanced stage lymphoma or high tumor burden leukemia, rasburicase is a safe and effective alternative to allopurinol during initial chemotherapy. ..
  29. Patte C, Sakiroglu C, Ansoborlo S, Baruchel A, Plouvier E, Pacquement H, et al. Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia, treated in the Société Française d'Oncologie Pédiatrique LMB89 protocol. Ann Oncol. 2002;13:789-95 pubmed
    To evaluate the frequency of metabolic complications and dialysis due to tumor lysis syndrome in patients with B-cell advanced-stage non-Hodgkin's lymphoma (NHL) and L3 leukemia at initiation of chemotherapy including the use of urate-..
  30. Lee A, Li C, So K, Chan R. Treatment of impending tumor lysis with single-dose rasburicase. Ann Pharmacother. 2003;37:1614-7 pubmed
    ..A shorter course of rasburicase treatment, including single-dose injection, is feasible and will improve the cost-effectiveness profile of the otherwise expensive compound. ..
  31. Kurt M, Onal I, Elkiran T, Altun B, Altundag K, Gullu I. Acute tumor lysis syndrome triggered by zoledronic Acid in a patient with metastatic lung adenocarcinoma. Med Oncol. 2005;22:203-6 pubmed
    We report the case of a 52-yr-old man with metastatic lung adenocarcinoma who developed tumor lysis syndrome after administration of zoledronic acid...
  32. Riccio B, Mato A, Olson E, Berns J, Luger S. Spontaneous tumor lysis syndrome in acute myeloid leukemia: two cases and a review of the literature. Cancer Biol Ther. 2006;5:1614-7 pubmed
    Spontaneous tumor lysis syndrome (TLS) is a constellation of electrolyte abnormalities and acute renal failure, which occurs in the setting of rapid cell turnover prior to the administration of cytotoxic chemotherapy...
  33. Ahamed S, Varma R, Mathew T, Hamide A, Badhe B. Spontaneous tumour lysis syndrome associated with non-Hodgkin's lymphoma--a case report. Indian J Pathol Microbiol. 2006;49:26-8 pubmed
    ..This rare occurrence was encountered in a patient with non-Hodgkin's lymphoma (NHL), of follicular cell type. Conservative but intensive treatment led to complete resolution. Subsequent chemotherapy was well tolerated. ..
  34. Vines A, Shanholtz C, Thompson J. Fixed-dose rasburicase 6 mg for hyperuricemia and tumor lysis syndrome in high-risk cancer patients. Ann Pharmacother. 2010;44:1529-37 pubmed publisher
    ..management of plasma uric acid levels in adults receiving anticancer therapy who are at risk for acute tumor lysis syndrome (TLS) and subsequent hyperuricemia. The labeled dose is 0...
  35. van den Berg H, Reintsema A. Renal tubular damage in rasburicase: risks of alkalinisation. Ann Oncol. 2004;15:175-6 pubmed
  36. Cairo M, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127:3-11 pubmed
    ..We summarise recent advances in the management of TLS and provide a new classification system and recommendations for prophylaxis and/or treatment based on this classification scheme. ..
  37. Lin C, Hsieh R, Lim K, Chen H, Cheng Y, Wu C. Fatal spontaneous tumor lysis syndrome in a patient with metastatic, androgen-independent prostate cancer. South Med J. 2007;100:916-7 pubmed
  38. Truong T, Beyene J, Hitzler J, Abla O, Maloney A, Weitzman S, et al. Features at presentation predict children with acute lymphoblastic leukemia at low risk for tumor lysis syndrome. Cancer. 2007;110:1832-9 pubmed
    b>Tumor lysis syndrome (TLS) is a well-recognized complication of acute lymphoblastic leukemia (ALL). The ability to predict children at differing risk of TLS would be an early step toward risk-based approaches...
  39. Jeha S, Pui C. Recombinant urate oxidase (rasburicase) in the prophylaxis and treatment of tumor lysis syndrome. Contrib Nephrol. 2005;147:69-79 pubmed
    Spontaneous or treatment-induced tumor lysis syndrome (TLS) can cause significant morbidity and potential mortality...
  40. Macfarlane R, McCully B, Fernandez C. Rasburicase prevents tumor lysis syndrome despite extreme hyperleukocytosis. Pediatr Nephrol. 2004;19:924-7 pubmed
    ..We conclude that WBC reduction strategies may not be required solely for the risk of tumor lysis syndrome in patients with very high WBC (>200 x 10(9)/l) who are treated with rasburicase.
  41. Hsu H, Chan Y, Huang C. Acute spontaneous tumor lysis presenting with hyperuricemic acute renal failure: clinical features and therapeutic approach. J Nephrol. 2004;17:50-6 pubmed
    Acute spontaneous tumor lysis syndrome (STLS) presenting with hyperuricemic acute renal failure (ARF) is a rare disease which can be overlooked in patients with neoplasic disorders, requiring prompt recognition and aggressive management...
  42. Cairo M, Coiffier B, Reiter A, Younes A. 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;149:578-86 pubmed publisher
  43. Montesinos P, Lorenzo I, Martin G, Sanz J, Perez Sirvent M, 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;93:67-74 pubmed publisher
    Despite the prophylactic use of allopurinol, tumor lysis syndrome (TLS)-related morbidity and mortality still occur in a number of patients with acute myeloid leukemia (AML)...
  44. Navolanic P, Pui C, Larson R, Bishop M, Pearce T, Cairo M, et al. Elitek-rasburicase: an effective means to prevent and treat hyperuricemia associated with tumor lysis syndrome, a Meeting Report, Dallas, Texas, January 2002. Leukemia. 2003;17:499-514 pubmed
    Renal precipitation of uric acid associated with tumor lysis syndrome (TLS) is a major complication in the management of leukemia, lymphoma, and other drug-sensitive cancers...
  45. Trifilio S, Gordon L, Singhal S, Tallman M, Evens A, Rashid K, et al. Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia. Bone Marrow Transplant. 2006;37:997-1001 pubmed
    ..No significant renal dysfunction developed in any of the patients. We conclude that rasburicase is effective in lowering uric acid levels at a fixed dose of 3 mg, which is much lower than the recommended dose. ..
  46. Bercovitz R, Greffe B, Hunger S. Acute tumor lysis syndrome in a 7-month-old with hepatoblastoma. Curr Opin Pediatr. 2010;22:113-6 pubmed publisher
    Acute tumor lysis syndrome (TLS) is characterized by the triad of hyperuricemia, hyperkalemia, and hyperphosphatemia and is caused by the death of tumor cells and release of intracellular contents into the circulation...
  47. Annemans L, Moeremans K, Lamotte M, Garcia Conde J, van den Berg H, Myint H, et al. Pan-European multicentre economic evaluation of recombinant urate oxidase (rasburicase) in prevention and treatment of hyperuricaemia and tumour lysis syndrome in haematological cancer patients. Support Care Cancer. 2003;11:249-57 pubmed
    ..In prevention the drug has an attractive economic profile in children, and is cost-effective in adults with ALL and NHL. ..
  48. Hummel M, Buchheidt D, Reiter S, Bergmann J, Adam K, Hehlmann R. Recurrent chemotherapy-induced tumor lysis syndrome (TLS) with renal failure in a patient with chronic lymphocytic leukemia - successful treatment and prevention of TLS with low-dose rasburicase. Eur J Haematol. 2005;75:518-21 pubmed
    ..by a genetically modified Saccharomyces cerevisiae and has been approved for prophylaxis and treatment of tumor lysis syndrome in 2001. In several studies, rasburicase, given at a dose of 0.15-0...
  49. Knoebel R, Lo M, Crank C. Evaluation of a low, weight-based dose of rasburicase in adult patients for the treatment or prophylaxis of tumor lysis syndrome. J Oncol Pharm Pract. 2011;17:147-54 pubmed publisher
    ..reserved for the treatment or prevention of hyperuricemia in patients that are at high risk of developing tumor lysis syndrome (TLS)...
  50. Pession A, Barbieri E. Treatment and prevention of tumor lysis syndrome in children. Experience of Associazione Italiana Ematologia Oncologia Pediatrica. Contrib Nephrol. 2005;147:80-92 pubmed
    Hyperuricemia and tumor lysis syndrome (TLS) are complications that can arise from treatment of rapidly proliferating and drug-sensitive neoplasms...
  51. Wright J, Lin D, Dewan P, Montgomery R. Tumor lysis syndrome in a patient with metastatic, androgen independent prostate cancer. Int J Urol. 2005;12:1012-3 pubmed
    b>Tumor lysis syndrome (TLS) is an uncommon, but well described, clinical entity that typically occurs following chemotherapy in patients with rapidly growing hematological malignancies. It is rarely described in patients with solid tumors...
  52. D alessandro V, Greco A, Clemente C, Sperandeo M, De Cata A, Di Micco C, et al. Severe spontaneous acute tumor lysis syndrome and hypoglycemia in patient with germ cell tumor. Tumori. 2010;96:1040-3 pubmed
    b>Tumor lysis syndrome has been observed in patients with bulky, treatment-sensitive tumors, in particular hematological malignancies, especially after medical treatment (chemotherapy, corticosteroids, radiation, hormonal agents, and ..
  53. Howard S, Pui C. Pitfalls in predicting tumor lysis syndrome. Leuk Lymphoma. 2006;47:782-5 pubmed