Tumor lysis syndrome

Abstract

TLS is a life-threatening oncological emergency caused by rapid lysis of malignant cells, either spontaneously or induced by chemotherapy.
The cornerstone of TLS management is to push fluids to increase excretion of urate and phosphate.
Drugs that lower serum urate have a key role in the management of TLS. Allopurinol reduces the formation of urate, but does not affect circulating urate or crytals deposited in the tissues. Rasburicase, a recombinant urate-oxidase enzyme, converts urate to soluble allantoin. Although rasburicase lowers uric acid more than allopurinol, there is currently no evidence of clinical benefit and it is extremely expensive.