Patients at risk of tumour lysis syndrome (TLS) during their treatment regimen should undergo rigorous and frequent monitoring of biochemical parameters to detect early metabolic disturbances. This includes baseline and serial measurements of serum electrolytes (potassium, phosphate, calcium), uric acid, creatinine, and lactate dehydrogenase (LDH) before and throughout treatment, with monitoring frequency tailored to the individual risk level and treatment phase NICE NG47.
Close monitoring should begin prior to initiating cytotoxic therapy and continue at least daily during the highest risk period, typically the first 72 hours after treatment initiation, to promptly identify hyperkalaemia, hyperphosphataemia, hypocalcaemia, and rising uric acid levels Tambaro & Wierda 2020. Renal function should be assessed frequently to detect acute kidney injury early, as this is a critical complication of TLS NICE NG47.
In addition to laboratory monitoring, clinical assessment for signs of TLS such as arrhythmias, seizures, or fluid overload is essential. Prophylactic measures including aggressive hydration and urate-lowering therapy should be guided by risk stratification and ongoing monitoring results NICE NG47 Tambaro & Wierda 2020. The integration of UK haematological cancer guidelines with recent literature emphasizes the importance of a multidisciplinary approach to monitoring, involving oncology, nephrology, and nursing teams to ensure timely intervention NICE NG47 Tambaro & Wierda 2020.
Key References
- CG32 - Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition
- NG99 - Brain tumours (primary) and brain metastases in over 16s
- NG47 - Haematological cancers: improving outcomes
- NG219 - Gout: diagnosis and management
- (Tambaro and Wierda, 2020): Tumour lysis syndrome in patients with chronic lymphocytic leukaemia treated with BCL-2 inhibitors: risk factors, prophylaxis, and treatment recommendations.