The tumor lysis syndrome is the most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers. This syndrome occurs when tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy, leading to the characteristic findings of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. These electrolyte and metabolic disturbances can progress to clinical toxic effects, including renal insufficiency, cardiac arrhythmias, seizures, and death due to multiorgan failure.
In the current classification system of Cairo and Bishop, the tumor lysis syndrome can be classified as laboratory or clinical.
Definitions of Laboratory and Clinical Tumor Lysis Syndrome.*
|Metabolic Abnormality||Criteria for Classification of Laboratory Tumor Lysis Syndrome||Criteria for Classification of Clinical Tumor Lysis Syndrome|
|Hyperuricemia||Uric acid >8.0 mg/dl (475.8 umol/liter) in adults or above the upper limit of the normal range for age in children|
|Hyperphosphatemia||Phosphorus >4.5 mg/dl (1.5 mmol/liter) in adults or >6.5 mg/dl (2.1 mmol/liter) in children|
|Hyperkalemia||Potassium >6.0 mmol/liter||Cardiac dysrhythmia or sudden death probably or definitely caused by hyperkalemia|
|Hypocalcemia||Corrected calcium <7.0 mg/dl (1.75 mmol/liter) or ionized calcium <1.12 (0.3 mmol/liter)†||Cardiac dysrhythmia, sudden death, seizure, neuromuscular irritability (tetany, paresthesias, muscle twitching, carpopedal spasm, Trousseau’s sign, Chvostek’s sign, laryngospasm, or bronchospasm), hypotension, or heart failure probably or definitely caused by hypocalcemia|
|Acute kidney injury‡||Not applicable||Increase in the serum creatinine level of 0.3 mg/dl (26.5 umol/liter) (or a single value >1.5 times the upper limit of the age-appropriate normal range if no baseline creatinine measurement is available) or the presence of oliguria, defined as an average urine output of <0.5 ml/kg/hr for 6 hr|
* In laboratory tumor lysis syndrome, two or more metabolic abnormalities must be present during the same 24-hour period within 3 days before the start of therapy or up to 7 days afterward. Clinical tumor lysis syndrome requires the presence of laboratory tumor lysis syndrome plus an increased creatinine level, seizures, cardiac dysrhythmia, or death.
† The corrected calcium level in milligrams per deciliter = measured calcium level in milligrams per deciliter + 0.8 × (4 – albumin in grams per deciliter).
‡ Acute kidney injury is defined as an increase in the creatinine level of at least 0.3 mg per deciliter (26.5 umol per liter) or a period of oliguria lasting 6 hours or more. By definition, if acute kidney injury is present, the patient has clinical tumor lysis syndrome.
- Howard SC, Jones DP, Pui C-H. The Tumor Lysis Syndrome. N Engl J Med 2011; 364:1844-1854 [Medline]
- 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 Jun 1;26(16):2767-78. [Medline]
Created May 12, 2011