Guidelines for Complications of Cancer Treatment Vol VIII Part B

of TLS and improve the management of patients withestablished TLS.2. Tumour lysis syndrome: new therapeuticstrategies and classification.Cairo MS, Bishop M. Br J Haematol. 2004 ;127:3-11.Tumour lysis syndrome (TLS) describes the metabolicderangements that occur with tumour breakdown followingthe initiation of cytotoxic therapy. TLS results from the rapiddestruction of malignant cells and the abrupt release ofintracellular ions, nucleic acids, proteins and their metabolitesinto the extracellular space. These metabolites can overwhelmthe body’s normal homeostatic mechanisms and causehyperuricaemia, hyperkalaemia, hyperphosphaetemia,hypocalcaemia and uraemia. TLS can lead to acute renal failureand can be life-threatening. Early recognition of patients atrisk and initiation of therapy for TLS is essential. There is ahigh incidence of TLS in tumours with high proliferative ratesand tumour burden such as acute lymphoblastic leukaemiaand Burkitt’s lymphoma. The mainstays of TLS prophylaxisand treatment include aggressive hydration and diuresis,control of hyperuricaemia with allopurinol prophylaxis andrasburicase treatment, and vigilant monitoring of electrolyteabnormalities. Urine alkalinization remains controversial.Unfortunately, there have been few comprehensive reviewson this important subject. In this review, we describe theincidence, pathophysiological mechanisms of TLS and riskfactors for its development. We summarise recent advances inthe management of TLS and provide a new classificationsystem and recommendations for prophylaxis and/or treatmentbased on this classification scheme.437