Optimizing management of tumor lysis syndrome in adults with hematologic malignancies

Tumor lysis syndrome (TLS), caused by the release of cellular components into the blood after rapid cell lysis, is a serious problem in patients with hematologic malignancies. It is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia, with serious clinical consequences including renal failure and death. Although TLS may occur spontaneously, it is more commonly caused by the destruction of malignant cells by chemotherapy. The risk of developing TLS is influenced by a number of characteristics including the type of malignancy, the type and intensity of anticancer treatment, and the presence of preexisting conditions such as renal insufficiency. Particularly, high-risk patients who have malignancies with a high rate of cell turnover are highly sensitive to chemotherapy. The identification and prophylactic treatment of patients at high risk of developing TLS is key to the management of TLS. This review provides a summary of the pathogenesis of TLS, risk factors for TLS, its associated incidence and clinical consequences, and pharmacologic options for prevention and treatment.