Tumor lysis syndrome in childhood malignancies

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Wing Lum Cheung MBBS, MRCPCH, Kam Lun Hon MBBS, MD (CUHK), FAAP, FCCM, Cheuk Man Fung MBChB, MRCPCH, Alexander KC Leung MBBS, FRCPC, FRCP (UK & Irel), FRCPCH, FAAP

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Background: Tumor lysis syndrome (TLS) is the most common life-threatening oncological emergency encountered by physicians treating children with lymphoproliferative malignancies. Healthcare providers should be aware of the condition in order to prevent occurrence and prompt timely management to avoid severe consequences.

Objective: To provide an update on the current understanding, evaluation, and management of tumor lysis syndrome in childhood malignancies.

Methods: A PubMed search was performed in Clinical Queries using the keywords ‘tumor lysis syndrome’ and ‘malignancies’ with Category limited to clinical trials and reviews for ages from birth to 18 years.

Results: There were 22 clinical trials and 37 reviews under the search criteria. TLS is characterized by acute electrolyte and metabolic disturbances resulting from massive and abrupt release of cellular contents into the circulation due to breakdown of tumor cells. If left untreated, it can lead to multiorgan compromise and eventually death. Apart from close monitoring and medical therapies, early recognition of risk factors for development of TLS is also necessary for successful management.

Conclusions: Prophylactic measures to patients at risk of TLS include aggressive fluid management and judicious use of diuretics and hypouricemic agents. Both allopurinol and urate oxidase are effective in reducing serum uric acid. Allopurinol should be used as prophylaxis in low-risk cases while urate oxidase should be used as treatment in intermediate to highrisk cases. There is no evidence on better drug of choice among different urate oxidases. The routine use of diuretics and urine alkalinization are not recommended. Correction of electrolytes and use of renal replacement therapy may also be required during treatment of TLS.

Keywords: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, lymphoproliferative malignancies.

Citation: Cheung WL, Hon KL, Fung CM, Leung AKC. Tumor lysis syndrome in childhood malignancies. Drugs in Context 2020; 9: 2019-8-2. DOI: 10.7573/dic.2019-8-2

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at https://www.drugsincontext.com/wp-content/uploads/2020/01/dic.2019-8-2-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2020 Cheung WL, Hon KL, Fung CM, Leung AKC. https://doi.org/10.7573/dic.2019-8-2. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Cheung WL, Hon KL, Fung CM, Leung AKC. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/tumor-lysis-syndrome-in-childhood-malignancies/

Provenance: invited; externally peer reviewed.

Submitted: 26 August 2019; Peer review comments to author: 30 October 2019; Revised manuscript received: 18 December 2019; Accepted: 23 January 2020; Publication date: 25 February 2020.

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