Incidence of chemotherapy-related tumour lysis syndrome at Kenyatta National Hospital, Nairobi

Objectives: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. Design: Prospective patient-treatment cohort study. Setting: National referral & teaching hospital, KNH; between November 2004 and April 2005. Subjects: One hundred and forty-two patients receiving first course chemotherapy. Main Outcome measure: Laboratory defined tumour lysis syndrome (TLS). Results: One hundred and eleven patients completed the study protocol. Forty-two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in nonhaematological malignancies was 3.6%. Hyperphosphataemia and hyperkalemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety-five percent of patients developed TLS within the first three days of receiving chemotherapy while fifty-five percent resolved in the first week. Two TLS case mortalities occurred. Conclusions: The incidence of TLS in this cohort study is 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.