29th December 2024

Risk factors for TLS

Risk stratifying allows the treating team to choose which patients to monitor closely or to offer prophylactic therapy.

Tumour type risk factors

TLS is generally associated with highly proliferative, chemosensitive cancers with a high burden of disease. It typically occurs in haematological malignancies, including ALL, AML, non-Hodgkin’s and Burkitt’s lymphoma. However, it can also occur in any solid tumour that has these risk factors, for example small cell lung cancer, breast cancer, renal cell cancer and metastatic testicular or germ cell cancers.

As options for SACT become more sophisticated and effective, the rates of TLS are likely to rise.

Patient risk factors

Patients with baseline biochemical abnormalities including high urate levels and chronic kidney disease are at higher risk of TLS. For the latter reason, the risk of TLS increases with age (thought to be due to worsening GFR). Exposure to nephrotoxic drugs may also increase the risk of TLS. Poor hydration status is also a risk factor, and some patients may require IV rehydration prior to commencing SACT.