Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) is a metabolic complication of rapid cell turnover and therefore is seen most frequently in pediatric oncology patients with large tumor burdens (often with renal parenchymal involvement), tumors with short doubling times and those exquisitely sensitive to cytotoxic therapy such as acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). TLS can include metabolic complications related to hyperkalemia, hyperphosphatemia (with resultant hypocalcemia) and hyperuricemia. Laboratory TLS (LTLS) should be differentiated from clinical TLS (CTLS); CTLS includes seizures, cardiac arrhythmias and acute kidney injury necessitating renal dialysis. Recognition of risk factors for LTLS and preventive therapy remain the most important management steps to minimize development of CTLS. The evidence basis behind recommendations in the management of TLS is often negligible and therefore based mostly on consensus statements; here we analyze the existing literature in relation to the consensus statements to determine and grade rational guidelines.