Tumor lysis syndrome and clinical guidelines

Abstract Tumor lysis syndrome(TLS)is a life-threatening metabolic abnormality caused by the massive and abrupt release of tumor cell components into the blood. TLS can be classified as laboratory TLS(LTLS)or clinical TLS(CTLS). LTLS is characterized by 2 or more of the following metabolic abnormalities: hyperuricemia, hyperkalemia, and hyperphosphatemia. CTLS comprises LTLS in addition to 1 or more of the following symptoms: renal insufficiency, cardiac arrhythmia/sudden death, and seizures. The prevention and treatment of TLS includes rigorous hydration, hyperuricemia management, and frequent monitoring of electrocytes and correction of electrolyte abnormalities. Rasburicase, a recombinant urate oxidase, can rapidly reverse hyperuricemia. With the introduction of rasburicase in clinical practice, a clinical practice guideline has been released and a recommended risk assessment method and prophylaxis have been advocated. This guideline can be applied uniformly to all patients, not only those with hematological malignancies, but also those with solid tumors. However, the medical environment is changing, with the introduction of a large number of molecular targeted drugs in clinical practice. In the rasburicase era, the serum phosphate concentration will become the most important risk factor associated with CTLS. This guideline will have to be re-evaluated in the near future.