Tumor Lysis Syndrome: Prevention and Management

Which patients are at risk for tumor lysis syndrome (TLS) in the modern oncology era, and how can clinicians best prevent and manage this potentially lethal complication?

Key Points

• Tumor lysis syndrome is most common in patients with aggressive hematologic malignancies undergoing intensive induction therapy but can occur in solid tumors, with other therapies, or even spontaneously (Figure 1).

• TLS leads to life-threatening metabolic disturbances and acute kidney injury (Figure 2), which often are driven by hyperphosphatemia rather than uric acid in the rasburicase era.

• Prevention includes risk stratification, hydration, and use of uric acid–lowering agents (e.g., allopurinol or rasburicase). Throughout the anticipated period of risk, c…