TLS - Tumor Lysis Syndrome Nephrology Grand Rounds Tuesday,...

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Tumor Lysis Syndrome Nephrology Grand Rounds Tuesday, July 27 th , 2010 Aditya Mattoo
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Outline Background/Definition Epidemiology/Risk Stratification Pathophysiology Treatment Renal Replacement Therapy
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Background/Definition
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Background Tumor lysis syndrome (TLS) was first described in 1929 by Bedrna and Polcak in patients with chronic leukemia. TLS is an oncologic emergency caused by the rapid and massive breakdown of tumor cells, either spontaneously or after the initiation of cytoreductive therapy. Usually occurs in patients with bulky, rapidly proliferating, and treatment-responsive tumors. Although TLS can potentially occur with any type of malignancy, it is most commonly associated with acute leukemias and high- grade non-Hodgkin lymphomas (e.g. Burkitt lymphoma). Bedrna et al. Med Klin. 25:p1700, 1929. Abu-Alfa et al. AJKD. 55:pS1, 2010.
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Background The rapid release of intracellular ions and metabolic byproducts into systemic circulation causes hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia. These metabolic abnormalities can lead to significant morbidity, putting patients at risk of severe clinical consequences that include acute kidney injury (AKI), cardiac arrhythmias, seizures, and even death. Choi et al. Ann Hematol. 88:p639, 2009.
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Definition a. Laboratory TLS is defined by any 2 or more of the listed values within 3 days before or 7 days after initiation of chemotherapy. b. Clinical TLS is defined by the presence of laboratory TLS plus at least 1 of the listed features in the absence of some other cause. Cairo et al. Br J Haematol. 127:p3, 2004.
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Grading System
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Epidemiology and Risk Stratification
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Epidemiology In children with acute leukemia receiving induction chemotherapy, silent laboratory evidence of TLS occurred in 70% of cases, but clinical TLS occurred in only 3% of cases. In a retrospective analysis of 722 adults and children (37% non- Hodgkin lymphoma, 36% ALL, and 27% AML), the incidence of clinical TLS was 5%. Of patients who developed TLS, 45% had AKI, 25% required dialysis, and 15% died as a result of TLS complications. Annemans et al. Leuk Lymphoma. 44:p77, 2004.
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Epidemiology Coiffier B et al. J Clin Oncology. 26:p2767, 2008.
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Risk Factors
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Risk Stratification Coiffier B et al. J Clin Oncology. 26:p2767, 2008.
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Pathophysiology
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Pathophysiology Clinically significant TLS can occur spontaneously, but it is most often seen 48-72 hrs after initiation of chemotherapy. Hyperkalemia and hyperphosphatemia result directly from
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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TLS - Tumor Lysis Syndrome Nephrology Grand Rounds Tuesday,...

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