Laboratory and Clinical Features of Tumor Lysis Syndrome in Children with Non-Hodgkin Lymphoma

Abstract

Tumor lysis syndrome (TLS) is a critical oncological emergency that can occur in children with non-Hodgkin lymphoma (NHL), particularly following the initiation of chemotherapy. This syndrome results from the rapid breakdown of malignant cells, leading to the release of intracellular components such as potassium, phosphate, and nucleic acids into the bloodstream. The subsequent metabolic derangements, including hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, can have severe clinical consequences, including acute kidney injury, cardiac arrhythmias, and neurological disturbances. The clinical presentation of TLS in pediatric patients can vary widely, ranging from asymptomatic laboratory abnormalities to life-threatening complications. Symptoms may include fatigue, nausea, palpitations, and seizures, often occurring within 24 to 48 hours after chemotherapy initiation. Laboratory findings are characterized by elevated serum levels of uric acid, potassium, and phosphate, alongside decreased calcium levels, necessitating prompt recognition and intervention. Risk factors for TLS in children with NHL include the type and stage of the lymphoma, the presence of a high tumor burden, and the specific chemotherapy regimen employed. Preventive strategies, such as aggressive hydration, the use of allopurinol or rasburicase, and close monitoring of metabolic parameters, are essential in mitigating the risk of TLS. In cases where TLS develops, immediate management is critical to stabilize the patient and address metabolic abnormalities. Understanding the laboratory and clinical features of TLS is vital for healthcare providers involved in the care of children with NHL. Early recognition and intervention can significantly improve patient outcomes, highlighting the importance of vigilance in monitoring at-risk pediatric patients during chemotherapy. Continued research into TLS mechanisms and management strategies is essential for enhancing the care of affected children.