155 - Oncology 911: Tumor Lysis Syndrome as an Oncologic Emergency

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 18 October 2022

⏱️ 45 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we invite Dr. Amir Ali, PharmD, BCOP to discuss with us the pathophysiology, risk factors, prevention, and treatment clinical pearls of tumor lysis syndrome TLS).

Key Concepts

TLS is caused by rapid cell death of cancerous cells that results in intracellular contents “spilling” into the blood – this leads to high serum uric acid, high serum potassium, high serum phosphate, and LOW calcium.
These laboratory abnormalities cause acute kidney injury (via crystal formation in the kidney), arrhythmias (from hyperkalemia), and seizures (from high phosphate and low calcium).
Patients at highest risk for TLS are those with hematologic malignancies (lymphomas and leukemias), especially if WBC or LDH labs are very high.
Prevention is the Key! The primary prevention approach for TLS is hydration, allopurinol, and sometimes a low dose of rasburicase. The treatment of TLS involves more aggressive hydration and rasburicase.

References

Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review [published correction appears in J Clin Oncol. 2010 Feb 1;28(4):708]. J Clin Oncol. 2008;26(16):2767-2778. doi:10.1200/JCO.2007.15.0177
Cairo MS, Coiffier B, Reiter A, Younes A; TLS Expert Panel. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 2010;149(4):578-586. doi:10.1111/j.1365-2141.2010.08143.x
Jones GL, Will A, Jackson GH, Webb NJ, Rule S; British Committee for Standards in Haematology. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015;169(5):661-671. doi:10.1111/bjh.13403

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not
0:22.0	professional advice and should not be used in lieu of obtaining advice from a qualified
0:26.0	health care provider. And now on to the show. Welcome to Helix Talk episode 155. I'm your
0:34.8	co-host Dr. Kane. And I'm Dr. Patel. And the title of today's episode is
0:39.2	Oncology 9-1-Tumurlysis Syndrome as an oncologic emergency. We actually have a very special
0:45.2	guest with us today, Dr. Amir Ali. Welcome to the podcast. Thank you, Dr. Kane and Dr.
0:51.0	Patel for having me on for this important topic today.
0:58.7	So why don't we go ahead and get started with kind of the nature of today's episode is tumor Lyce syndrome, but before we get into that, Dr. Lee, maybe you could just tell the audience a little bit about yourself and why you are on today's episode.
1:07.1	Absolutely, Dr. Kane. So I went to school at University of California, San Francisco,
1:12.6	UCSF in the Bay Area, completed my first year residency with Kaiser Permanente and my second year
1:17.6	residency in hematology oncology at USC University of Southern California and stayed on there and practiced.
1:24.6	So my role is pretty unique down there. So I don't work in a pharmacy. I work
1:29.4	in the clinics with patients. I deal with mostly hematology and bone marrow transplants down there.
1:35.1	And on the side, I'm also an adjunct assistant professor, a lot of involvements with P&T policies,
1:41.9	and also the residency program coordinator at USC for our
1:46.3	oncology program there.
1:47.7	Well, that sounds great.
1:49.8	And you know, a person like me who has nothing to do with oncology will ask, why do
1:55.5	people who are not oncology specialists need to be familiar with the tumor license syndrome.
2:01.4	So what do you have to say?
	...

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