Side Effects > Tumor Lysis

Last update: 11/11/2005

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Tumor lysis syndrome (TLS) can be a complication of having chemotherapy.  It can be a very serious and sometimes life-threatening complication most commonly occurring after chemotherapy treatment in patients with leukemia or high grade lymphoma.

"What is tumor lysis syndrome? There's no good definition, but we can define it as metabolic derangement produced by rapid tumor breakdown as a consequence of therapy. It's characterized by hyperuricemia due to deoxyribonucleic acid (DNA) breakdown, hyperkalemia because of cytosol breakdown, hyperphosphatemia because of protein breakdown, and hypocalcemia secondary to the hyperphosphatemia. As phoshate level goes up, serum calcium goes down. These derangements can result in acute renal failure secondary to urate nephropathy but also due to xanthine nephropathy. Also, calcium phosphate can contribute to renal failure.

Cardiac dysrhythmias can occur secondary to hyperkalemia and hypocalcemia, molecular symptoms such as cramps can occur secondary to hypocalcemia, and there can be sudden death from hyperkalemia or hypocalcemia.

When we treat patients with non-Hodgkin's lymphoma, we frequently find tumor lysis syndrome; many times it's not clinically significant. In other words, when there is tumor cell kill, you can get some hyperuricemia and some hyperphosphatemia but, if it's not severe enough, it will not result in the full-blown picture which is known as clinically significant tumor lysis syndrome."  -  Medscape (free login req.)

Signs and symptoms:

In early stages, patients may have no symptoms but progression of the syndrome may lead into:
 

• Irregular heartbeat
   
• Impairment of mental ability, and loss of consciousness 
   
• Kidney failure
   
• Shortness of breath
   
• High Potassium levels (lab test)
   
• High Uric acid levels (lab test)
   
• Low calcium levels (lab test)
   

Resources and Articles:

• * Malignancy-Associated Metabolic Abnormalities in Non-Hodgkin's Lymphoma
  Fernando Cabanillas, MD ~Tumor Lysis Syndrome: 
  Definition and Predictive Factors - Medscape (free login req.)

• About - emedicine.com | www.tlsed.net | cancerhelp.org.uk 

• Tumor lysis syndrome: an uncommon complication of fludarabine therapy 
  of chronic lymphocytic leukemia - B. Cheson