Clinical presentation and diagnosis

Patients with TLS are diagnosed based on laboratory monitoring indicating hyperuri-

cemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and renal dysfunction. As a result of these electrolyte abnormalities, patients may present with uremia, visual disturbances, muscle cramping, edema, hypertension, cardiac arrhythmias, seizures,

and even sudden death.

FIGURE 99-6. The role of allopurinol and rasburicase in the enzymatic degradation of purine nucleic acids.

Table 99-14 Risk Factors for TLS

Disease Related High risk

Acute lymphoblastic leukemia

High-grade non-Hodgkin's lymphoma (i.e., Burkitt's) Intermediate risk

Chronic lymphocytic leukemia (especially bulky lymphadenopathy) Acute myeloid leukemia (especially WBC greater than 50,000/mm ) Multiple myeloma Low risk

Low- and intermediate-grade non-Hodgkin's lymphoma Hodgkin's disease

Chronic myeloid leukemia (blast crisis)

Rare

Breast cancer

Small cell lung cancer Testicular cancer Patient related

Decreased urinary output, dehydration, or renal failure Pre-existing hyperuricemia Acidic urine

Lactate dehydrogenase (LDH) levels greater than 1500 IU/L (1500 units/L) High tumor sensitivity to treatment modalities

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