What Is Tumor Lysis Syndrome?

It can occur in any patient with rapid tumor cell proliferation and massive tumor cell death after treatment. It is generally common in acute leukemia and highly malignant lymphoma, and less common in patients with solid tumors, such as small cell lung cancer, germ cell malignant tumors, and primary Liver cancer etc. Tumor lysis syndrome has the following characteristics: metabolic abnormalities such as hyperuricemia, hyperkalemia, and hypocalcemia caused by hyperphosphatemia. A few severe cases can also occur with acute renal failure, severe arrhythmias such as ventricular tachycardia and ventricular fibrillation, and DIC (diffusive intravascular coagulation). Clinicians should identify patients at high risk for tumor lysis syndrome, strengthen prevention and testing, and begin treatment as soon as they are found.

Tumor lysis syndrome

It can occur in any patient with rapid tumor cell proliferation and massive tumor cell death after treatment. It is generally common in acute leukemia and highly malignant lymphoma, and less common in patients with solid tumors, such as small cell lung cancer, germ cell malignant tumors, and primary Liver cancer etc. Tumor lysis syndrome has the following characteristics: metabolic abnormalities such as hyperuricemia, hyperkalemia, and hypocalcemia caused by hyperphosphatemia. A few severe cases can also occur with acute renal failure, severe arrhythmias such as ventricular tachycardia and ventricular fibrillation, and DIC (diffusive intravascular coagulation). Clinicians should identify patients at high risk for tumor lysis syndrome, strengthen prevention and testing, and begin treatment as soon as they are found.

Tumor lysis syndrome prevention

Leukemia, lymphoma and other patients were given allopurinol 600 mg / d 24 hours before chemotherapy, orally for 1-2 days. Thereafter, allopurinol can be administered, 300 mg orally daily. For patients who need immediate rescue, give the same dose of allopurinol, and need to basify the urine (pH> 7), intravenously inject a solution containing 0.4% sodium bicarbonate and a diuretic to maintain the urine volume at 100-150mL / h. After sufficient fluid is given, if the desired urine volume is not reached, furosemide may be administered intravenously 20 mg. If the urine pH is <7.0, increase the amount of sodium bicarbonate or 250 mg orally acetazolamide four times a day.

Tumor lysis syndrome monitoring

For those at risk, serum electrolytes, phosphorus, calcium, uric acid, and creatinine should be measured at least once a day before and during chemotherapy. For high-risk patients (such as highly malignant lymphoma with large tumor volume), the above-mentioned experimental indicators are detected every 6 hours between 24 hours and 48 hours after the start of treatment. During the test, once the serum value is abnormal, appropriate treatment should be given, and the abnormal value is repeated every 6 to 12 hours until the chemotherapy is completed or the normal laboratory value is reached.

Tumor lysis syndrome treatment

After diagnosis, sufficient semi-saline hydration therapy must be given. Oral aluminum hydroxide can be used to treat hyperphosphatemia.

There are many ways to treat hyperkalemia, but there are two types of mechanisms:

One is to promote the transfer of potassium ions into the cell (glucose, insulin or sodium bicarbonate), and the other is to make potassium excrete quickly (fast urinary urges its excretion through urine, sodium polystyrene sulfonate resin promotes its excretion through intestine) . Patients with hyperkalemia or hypocalcemia should undergo an electrocardiogram and monitor the heart rhythm for a long time until the hyperkalemia is corrected. For potential arrhythmias secondary to hyperkalemia and hypocalcemia, calcium can be administered intravenously to protect the heart muscle. The recommended treatments are as follows:

1. Serum potassium is not higher than 5.5mmol / L, increase the amount of intravenous infusion, and normal saline and intravenous administration of furosemide (20mg) is sufficient. 2 ampoule sodium bicarbonate (89mmol / L) can also be used instead of normal saline plus 1 liter of 5% glucose or water.

2. The serum potassium level is between 5.5-6.0mmol / L, the amount of intravenous infusion and the amount of furosemide are increased, and 30 g of sodium polystyrene sulfonate resin and sorbitol are taken orally.

3 If the serum potassium level is higher than 6.0mmol / L or there is obvious arrhythmia, multiple methods should be used in combination. First give 10ml of 10% calcium gluconate solution intravenously, then increase the intravenous fluid input and furosemide dosage plus 50% glucose 20mL and 10 units of ordinary insulin. Oral administration of sodium polystyrene sulfonate resin and sorbitol can also be contraindicated in patients with a history of congestive heart failure or patients with left ventricular dysfunction. Dialysis can be used for refractory hyperkalemia.