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Case History

Image not available. A 33-year-old man with newly diagnosed aggressive non-Hodgkin lymphoma is admitted to receive his first cycle of chemotherapy. The patient has no significant medical history and takes no prescribed medicines. His father has glucose-6-phosphate dehydrogenase deficiency.

How may the risk of tumour lysis syndrome be gauged?

What prophylactic therapies are available? Which should the patient receive?

What are the complications of tumour lysis syndrome and how should this patient be monitored?


Image not available. Tumour lysis syndrome (TLS) is a potentially lethal clinicopathological syndrome caused by rapid lysis of malignant cells. The consequent metabolic derangements give rise to a spectrum of symptoms, which are listed in Table 13.1. TLS may be present prior to treatment, due to high cell turnover, but more usually occurs 12-72 hours after initiation of therapy.

Table 13.1Clinicopathological features of tumour lysis syndrome (TLS)

How may the risk of tumour lysis syndrome be gauged?

Factors influencing the risk of TLS may be grouped into disease, patient and treatment factors. Table 13.2 gives a guide to risk assessment for some more common situations in adult oncology, although each patient requires a personalized assessment of risk.

Table 13.2Evaluation of risk and prophylaxis of tumour lysis syndrome. Adapted from (1).

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