Tumor Lysis Syndrome
| Classification according to ICD-10 | |
|---|---|
| E88.3 | Tumor Lysis Syndrome |
| ICD-10 online (WHO version 2019) | |
As tumor lysis syndrome (Engl. Tumor lysis syndrome ) refers to a potentially life-threatening condition of the rapid disintegration of tumors (usually with chemotherapy can occur treatment).
Causes, pathophysiology
Certain rapidly growing tumors are relatively sensitive to chemotherapeutic treatment; H. With ongoing chemotherapy, large numbers of tumor cells are destroyed by the treatment in a very short time. As a result, many ingredients are released from the inside of the tumor cells into the bloodstream and can lead to a metabolic derailment. The following substances are decisive for the development of this metabolic derailment:
- Uric acid , a final breakdown product of nucleic acids
- phosphate
- Potassium , which is present in high concentrations inside cells, but only in low concentrations in blood serum
- Calcium waste due to the failure of calcium phosphate.
If these substances accumulate in large quantities in a short time (calcium drops), it can lead to metabolic imbalances and, in particular, damage to the kidney function , as the household of these above mentioned. Substances are essentially regulated by their excretion by the kidneys. The decisive factor is usually uric acid, which, if suddenly formed in large quantities, can no longer be adequately excreted via the kidneys, crystallizes in the kidneys and leads to urate nephropathy (urates = salts of uric acid). In the worst case scenario , acute kidney failure occurs , which can lead to chronic dialysis .
As a general rule, there is a risk of tumor lysis syndrome, particularly in rapidly growing tumors that are sensitive to chemotherapy. First and foremost, these include:
- acute leukemia : acute lymphocytic leukemia , acute myeloid leukemia
- Malignant lymphomas , especially very fast-growing lymphomas: Burkitt's lymphoma , diffuse large-cell lymphoma
An intermediate risk exists with:
prevention
For prophylaxis of tumor lysis syndrome, various measures can be taken:
- intravenous infusions to give the kidneys a good flush (this dilutes the substances that the kidneys excrete)
- Administration of allopurinol (inhibits uric acid formation) or rasburicase (Fasturtec ® ) (risk-adapted)
- Urine - alkalization through appropriate infusions or medication: in the alkaline range the uric acid is mainly present as urate salt and is much more soluble in water and can be excreted more easily.
If tumor lysis syndrome is feared, chemotherapy should be started slowly and carefully. With the above Leukemia and lymphoma are usually treated in such a way that a relatively mild, so-called pre - phase therapy is used, during which there is a slow, relatively controlled tumor breakdown. The drugs used in pre-phase therapy for lymphatic diseases are glucocorticoids ("cortisone") and vincristine or low-dose cyclophosphamide .
treatment
Once a tumor lysis syndrome has occurred, one must first and foremost treat acute kidney failure and ensure that the derailed blood values are balanced (see above). Rasburicase (Fasturtec ® ), a recombinant enzyme that breaks down uric acid, can be given to treat the acutely high uric acid level (expensive therapy). Allopurinol should no longer be administered in acute kidney failure.
literature
- J. Hochberg, MS Cairo: Tumor lysis syndrome: current perspective. In: Haematologica . 2008 Jan; 93 (1), pp. 9-13. PMID 18166779
