Tumor Lysis Syndrome: Treatment

Tumor Lysis Syndrome is a group of metabolic complications that may arise after treatment of neoplasms, especially in cases of lymphoma and leukemia, and in some cases even when no previous treatment has been carried out.

The types of lymphoma involved in the disorder are not well differentiated such as Burkitt’s lymphoma. On the other hand, acute lymphoblastic leukemia and acute myeloid leukemia could also lead to this disorder. Other types of malignant tumors associated with this disorder, such as melanoma, can rarely be observed.

Typically, in relation to the initiation of the syndrome therapy it involves chemotherapy and steroids, and may arise spontaneously, without carrying out a previous treatment. The factors that trigger this disorder are the complications of cellular debris after the destruction of cancer cells during treatment.

Clinically, tumor lysis syndrome is characterized by:

Hypercalcemia: Symptoms of the disease usually appear only when intracellular potassium levels are very high (more than 7 mmol / L) can lead to heart abnormalities, muscle weakness or severe paralysis.

Hyperphosphatemia: can lead to acute renal failure, due to the accumulation of calcium phosphate crystals in the renal parenchyma.

Hypocalcemia: can lead to tetany, seizures, sudden mental disability, parkinsonian symptoms, papilledema, and myopathy.

Hyperuricemia and hyperuricosuria: the presence of acute nephropathy due to uric acid due to hyperuricosuria has been shown to be the dominant cause of acute renal failure. However, due to the existence of an effective treatment for the latter, hyperphosphatemia has become a cause in comparison more infrequent. It should be suspected in cases of tumor lysis syndrome of cancer patients who develop acute renal failure associated with hyperuricosuria. A urinalysis can point to the presence of uric acid crystals or amorphous urates. In addition, by means of urine analysis it is possible to identify the elevated excretion of uric acid.

Treatment

The treatment is aimed at preventing the onset of acute renal failure, which leads to a considerable increase in the clinical manifestations of the syndrome, as well as its clinical consequences. Therefore, it can be done to control hyperuricemia and the prevention of nephrocalcinosis. This is done by renal replacement therapy, when it is not possible to control the metabolic alterations in the 6 hours after the prevention implemented. However, if there is still acute renal injury, extrarenal treatment should be initiated, with the goal of clearance of uric acid and phosphate to minimize renal failure. In addition, hydration is very important for this disorder, and drugs that reduce urate levels can also be used.

A literature review / acute complete tumor lysis syndrome: a comprehensive review.

Source: Rev. Bras. intensive, 20 (3): 278-285, July-September Illus 2008, tab. Language: es; pt.

Abstract: The tumor lysis syndrome is characterized by a massive destruction of malignant cells and the consequent release of their contents in the extracellular space. Although it can occur spontaneously, tumor lysis syndrome usually appears shortly after starting treatment with cytotoxic chemotherapeutic agents. Once released, these metabolites can overwhelm the homeostatic mechanisms that result in hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia.

These biological changes can lead to the appearance of various clinical manifestations, including acute renal failure, seizures and sudden death, which may require intensive care. As the tumor lysis syndrome is associated with a poor prognosis, the prevention of its occurrence and its consequences is also mandatory. The objective of this review is to describe the pathophysiology and clinical and biological manifestations of acute tumor lysis syndrome, and to provide updated recommendations for prevention.

The articles of tumor lysis published in the last 20 years of the portal www.ncbi.nlm.nih.gov/pubmed/ were selected. The studies mentioned in the selected articles were also used.

Results: Tumor lysis syndrome is a serious and frequent complication in patients with newly diagnosed malignant tumors. Prevention strategies include vigorous hydration, uricolytic agents, the identification of predisposing factors for acute renal injury and in critical patients in the prophylactic methods of renal replacement necessary to prevent or mitigate their consequences. However, the optimal timing and modalities of being prevention remains unknown and can be modified by changes in the spectrum of patients at risk of developing it. The development and validation of strategies based on patient risk are necessary to limit high morbidity and mortality.