Review Article

Managing Tumor Lysis Syndrome in the Era of Novel Cancer Therapies

Ali McBride,(1) PharmD, MS, BCPS, BCOP, Steven Trifilio,(2) RPh, Nadine Baxter,(3) MNSc, APN-BC, AOCNP®, Tara K. Gregory,(4) MD, and Scott C. Howard,(5) MD, MS

1)The University of Arizona Cancer Center, Tucson, Arizona; 2)Northwestern Memorial Hospital, Chicago, Illinois; 3)University of Arkansas for Medical Sciences, Myeloma Institute for Research and Therapy, Little Rock, Arkansas; 4)Colorado Blood Cancer Institute at Presbyterian St. Luke’s Medical Center, Denver, Colorado; 5)University of Memphis, School of Health Studies, Memphis, Tennessee

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Ali McBride, PharmD, MS, BCPS, BCOP, The University of Arizona Cancer Center, 3838 N. Campbell Avenue, PO Box 245219, Tucson, AZ 85719. E-mail: Ali.McBride@uahealth.com

ABSTRACT

Abstract

Tumor lysis syndrome (TLS) is a potentially life-threatening emergency that can develop rapidly after the release of intracellular contents from lysed malignant cells. The advent of novel and targeted therapies that have improved tumor-killing efficacy has the potential to increase the risk of TLS when used as part of front-line therapy. A recent review of TLS risk in patients with hematologic malignancies treated with newer targeted agents highlighted the need to revisit TLS risk stratification and to describe the practical challenges of TLS prevention, treatment, and monitoring. Although this era of rapid development of novel cancer therapies provides new hope for patients with hematologic malignancies, it is essential to be prepared for TLS because monitoring and prophylaxis can almost always prevent severe and life-threatening consequences. Heightened awareness of the development of TLS with novel and targeted agents, accompanied by aggressive hydration and rational, risk-appropriate management, are the keys to successful outcomes.

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