Current Standards and Best Practices in the Management of Tumor Lysis Syndrome

STATEMENT OF NEED

Tumor lysis syndrome (TLS) is a rare, potentially life-threatening oncologic emergency typically associated with chemotherapy-induced tumor cell death in which potassium, phosphate, and nucleic acids are released into the bloodstream. This release of intracellular materials results in severe metabolic abnormalities such as hyperuricemia and hyperphosphatemia, which may cause acute renal injury, and hypokalemia and hypocalcemia, which may cause seizures, neuromuscular symptoms, and cardiac arrhythmias. The occurrence of TLS may prevent or delay the administration of potentially life-saving chemotherapy. Furthermore, the kidney damage, heart failure, fluid retention, and neuromuscular and gastrointestinal effects caused by TLS may lead to reductions in chemotherapy dosing and alter the selection of cytotoxic agents. The most effective management strategy is prevention; however, despite appropriate prophylactic measures, approximately 3% to 5% of high-risk patients receiving chemotherapy are affected. The overall mortality rate of patients with TLS is 15%.

TARGET AUDIENCE

Hematology/oncology physicians, hematology/oncology fellows, oncology advanced practitioners, oncology nurses, and other health care professionals involved in the treatment of cancer patients at risk for TLS.

LEARNING OBJECTIVES

Upon completion of this activity, participants should be able to:

1. Assess the risk for TLS in patients receiving current and emerging therapies for hematologic malignancies
2. Differentiate the signs and symptoms of TLS
3. Evaluate evidence-based strategies for the prevention and treatment of TLS

Note: The learning objectives listed above apply to nurse practitioners and registered nurses in addition to physicians.