Tumour lysis syndrome; new approaches in diagnosis follow up and treatment

Abstract

Tumor lysis syndrome is a clinical picture which occurs with the lysis of malignant cells and causes metabolic abnormalities that threatens life These metabolic abnormalities are caused by the release of intracellular ions nucleic acids proteins and their metabolites from the instantly degraded tumor cells These rapidly released metabolites can impair the body rsquo;s normal homeostatic mechanism and cause uremia hyperuricemia hyperkalemia and hyperphosphatemia Hypocalcemia which is commonly seen in tumor lysis syndrome is secondary to hyperphosphatemia Generally tumor lysis syndrome occurs after the initiation of chemotherapy but it is rarely observed in fast growing tumours before the treatment due to spontaneous lysis of malignant cells The possibility of tumor lysis syndrome is higher in tumours with high proliferative rates and high tumour burden including Burkitt rsquo;s lymphoma and acute lymphoblastic leukemia The principle of prophylaxis treatment of tumour lysis syndrome includes virgous hydration adequate diuresis control of hyperuricemia with rasburicase or allopurinol regulation of serum electrolytes and dialysis if necessary If the necessary measures are not taken or the clinal situation is not treated properly metabolic abnormalities can cause renal insufficiency cardiac arrhythmia neurologic complications and propably sudden death in patients with cancer Alkalization of urine used to be applied to all patients previously but it is not recommended any longer and this issue is still open to debate In this paper new approaches and innovations in the treatment of tumor lysis syndrome are discussed Turk Arch Ped 2013; 48: 188 194

Keywords

• Allopurinole, rasburicase, tumour lysis syndrome

Tümör lizis sendromu; tanı izlem ve tedavide yeni yaklaşımlar

Öz

Tümör lizis sendromu tümör hücrelerinin hızlı bir şekilde yıkılmasıyla ortaya çıkan ve yaşamı tehdit edebilen metabolik anormalliklerle seyreden klinik bir tablodur Bu metabolik anormallikler ani yıkılan tümör hücrelerinden hücre içi iyon nükleik asit protein ve metabolitlerinin hücre dışı sıvıya sızması sonucunda oluşur Bu hızlı salınan metabolitler vücudun normal hemostatik mekanizmasını bozarak üremi hiperürisemi hiperkalemi ve hiperfosfatemiye neden olabilir Tümör lizis sendromunda sıkça görülen hipokalsemi ise hiperfosfatemiye ikincil olarak ortaya çıkar Tümör lizis sendromu genellikle kemoterapinin başlanmasından sonra görülse de nadiren hızlı büyüyen tümörlerde malin hücrelerin kendiliğinden yıkımı sonucunda tedaviden önce de ortaya çıkabilir Çoğalma hızı fazla tümör yükü yüksek olan Burkitt lenfoma ve akut lenfoblastik lösemi gibi malinitelerde tümör lizis sendromu görülme ihtimali daha yüksektir Tümör lizis sendromu gelişmesini önlemek ve tedavinin esasını yoğun hidrasyon yeterli diürez allopürinol ve veya rasburikaz tedavisi ile hiperüriseminin kontrolü serum elektrolitlerinin düzenlenmesi ve lüzum halinde diyaliz tedavisi oluşturur Gerekli önlemler alınmaz veya oluşan klinik tablo tedavi edilmez ise metabolik anormallikler kanser hastalarında böbrek yetersizliği kardiyak aritmi nörolojik komplikasyon ve muhtemel ani ölüme neden olabilir Daha öncelerde her hastada uygulanan idrarın alkalizasyonu ise son yıllarda pek önerilmemektedir ve bu konu halen tartışmaya açıktır Bu yazıda tümör lizis sendromu ve tedavisi sırasında değişen yaklaşımlar ve yeniliklerden bahsedilecektir.

Anahtar Kelimeler

• Allopürinol
• rasburikaz
• tümör lizis sendromu

Kaynakça

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