Tumor Lysis Syndrome in Adults with Hematologic Malignancies

Abstract

Introduction: Tumor lysis syndrome (TLS) is a metabolic complication commonly seen in patients with hematologic malignancies, particularly high-grade non-Hodgkin lymphomas and acute leukemia. It is characterized by biochemical abnormalities that can lead to cardiac, neurological, and renal complications that can be fatal. The purpose of our study is to describe the epidemiology, laboratory profile and the outcome of TLS in order to identify patients at risk, and to implement appropriate prophylactic measures to prevent the clinical repercussions. Material and Methods: This work is a retrospective study of all patients who developed a laboratory TLS in hematologic malignancies according to the classification of Cairo and Bishop over a period of 3 years (from November 2019 to November 2022), and whose data were collected at the adult hematology unit of the Mohammed VI University Hospital of Tangiers. Results: The incidence of TLS among hematologic malignancies identified during this period was 3.7%. The underlying disease was acute leukemia in 10 patients (55.6%) and high-grade lymphoma in eight patients (44.4%). TLS was spontaneous in fifteen cases (83%) and chemotherapy-induced in three cases (17%). All our patients presented with hyperphosphatemia. 94% of cases had hyperuricemia, 44% of cases had hypocalcemia, while 6% of cases had hyperkalemia. Lactate dehydrogenase levels were elevated in all cases. Treatment consisted of hyperhydration and administration of hypouricemic agents in all cases. Three patients received hemodialysis. The outcome was favorable in 83% of cases and 17% of cases died during follow-up. Conclusion: TLS is a severe complication, most often seen in highly proliferative hematologic malignancies. The role of the laboratory remains paramount in the diagnosis of TLS and in the biological monitoring after the implementation of appropriate therapeutic measures.