Tls
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Tumor lysis syndrome is characterized by metabolic imbalances that develop after chemotherapy treatment begins rapidly destroying cancer cells. It most often affects cancers with high proliferation rates and response to treatment, like aggressive lymphomas and leukemias. As malignant cells are destroyed, they release intracellular components into circulation, potentially causing hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. This can impair kidney function through uric acid crystallization in the renal tubules. Risk factors include high tumor burden, rapid growth rate, responsive cancer to therapy and preexisting hyperuricemia.
Tls
- 2. TUMOR LYSIS SYNDROME Tumor lysis syndrome (TLS) is characterized by an array of metabolic imbalances associated with the rapid destruction of a large number of WBCs. that develop inpatients with cancer after the onset of chemotherapy treatment or, less often, prior to treatment. Contd …
- 3. TUMOR LYSIS SYNDROME TLS has been reported most often in patients Suffering from malignancies with a high rate of proliferation, especially cancers with a high response rate and rapid responses to cytotoxic therapy. Contd …
- 4. TUMOR LYSIS SYNDROME These include aggressive non-Hodgkin lymphoma, notably diffuse large B-cell lymphoma, lymphoblastic lymphoma, and Burkett lymphoma; acute and chronic leukaemia's ; and, less often, bulky solid tumors.
- 5. TIMING Occurs 24-48 hours into treatment May persist up to one week
- 6. CAUSES of TLS • Following the administration of therapy, malignant cells are destroyed rapidly releasing into circulation intracellular components.
- 7. Risk Factors • high tumor burden • high rate of proliferation • and disease that is highly responsive to therapy • Bulky tumors ( > 8-10cm)
- 8. Other Risk Factors • Pre-existing Hyperuricemia • ≥ 60 years old
- 9. Spontaneous TLS • Release of purine metabolites that result in metabolic abnormalities • > Highly proliferative, poorly differentiated malignancies • - Burkett's lymphoma/ leukemia - Acute lymphoblastic lymphoma/ leukemia
- 10. Treatment Induced TLS • Chemotherapy/Biotherapy • Radiation therapy • Corticosteroids
- 11. Spontaneous vs Treatment Induced • Usually no elevation in phosphorous in spontaneous tumor lysis syndrome • Postulated: rapid proliferation rates of tumor cells can increase uric acid levels through rapid nucleoprotein turnover • Tumor then utilizes released phosphorus for synthesis of new tumor cells
- 12. Characteristic Abnormalities Associated With Tumor Lysis Syndrome Hyperuricemia Hyperkalemia Hyperphosphatemia Hypocalcemia Followed by IMPAIRMENTOF KIDNEYFUNCTION
- 13. HYPERURICEMIA • Hyperuricemia is an excess of uric acid in the blood. • NORMAL LEVEL • 2.4-6.0 mg/dL (female) • 3.4-7.0 mg/dL (male)
- 14. HYPERURICEMIA • Nausea/vomiting/Diarrhea • Anuria • Oliguria • Flank pain • Cloudy urine • Uric acid crystalluria • Renal Obstruction • Acute Renal Failure
- 15. PATHOPHYSIOLOGY RISK FACTORS: • High tumor burden • High rate of proliferation • Disease that is highly responsive to therapy • Bulky tumors ( > 8-10cm) • Pre-existing Hyperuricemia • ≥ 60 years old Leading to TUMOR RESPONDS RAPIDLY Causing DESTRUCTION OF A LARGE NUMBER OF MALIGNANT CELLS
- 16. Uric Acid Nephropathy Direct result of ↑ UA crystals forming in renal tubules and distal collecting system When associated with TLS it is more likely to see oliguria(<100 ml/d) or anuria In this patient, normalization of PO4 is necessary for quick recovery of renal function