Etiology and management of tumor lysis syndrome in patients with chronic lymphocytic leukemia.

In the past few years, the number of effective treatment options for patients with chronic lymphocytic leukemia (CLL) has increased substantially. Purine analogs, bendamustine, monoclonal antibodies, and immunomodulatory drugs have shown higher response rates than previously achieved with standard CLL treatments such as alkylating agents. However, a consequence is that increased rates of tumor-cell killing may be accompanied by adverse secondary effects. One well-known consequence of rapid and massive cell killing is a group of metabolic disruptions collectively known as tumor lysis syndrome (TLS). TLS can be life threatening or fatal when unrecognized and/or untreated, and may cause delays in treatment of the underlying disease. It is important to be aware of patient risk factors, prophylactic measures, diagnostic criteria, and treatment for TLS. This review discusses the relevance of TLS to CLL treatment and provides guidelines for diagnosis, prevention, and treatment of TLS in patients being treated for CLL.