Table 2.
Acute tumour lysis syndrome: associated malignancies, risk factors, clinical presentation and prophylactic treatment
| Malignancies associated with TLS | |
| High risk | High-grade non-Hodgkin's lymphoma |
| Acute lymphoid leukaemia | |
| Acute myeloid leukaemia | |
| Intermediate risk | Myeloma |
| Low-grade non-Hodgkin's lymphoma | |
| Small-cell lung carcinoma | |
| Low risk | Medulloblastoma |
| Breast or gastrointestinal carcinoma | |
| Risk factors | Tumour spread |
| Rapid tumour growth | |
| Chemosensitive tumour | |
| LDH >1,500 IU/l | |
| Hypokalaemia/hypophosphataemia | |
| Pre-existing renal failure | |
| Clinical presentation | |
| Hyperkalaemia | Intracellular potassium release |
| Hyperphosphataemia | Intracellular PO4- release |
| Calcium phosphate deposition | |
| Hypocalcaemia | Calcium phosphate deposition |
| Rarely symptomatic | |
| Hyperuricaemia | Nucleic acid degradation |
| Acute renal failure | |
| Prevention | Volume expansion |
| Urate oxidase if risk factor for TLS | |
| Urine alkalisation controversial | |
| Do not correct hypocalcaemia if asymptomatic | |
| If [calcium] × [phosphate] remains above 4.6 despite prophylactic measures, initiate renal replacement therapy | |
| Avoid correction of hypokalaemia or hypophosphoraemia before induction |
LDH, lactate dehydrogenase; TLS, tumour lysis syndrome.