Tumor lysis syndrome (TLS) is a potentially life-threatening condition and oncologic emergency that is caused by treatment-associated or spontaneous lysis of hematologic or solid tumor cancer cells. Rapid lysis of tumor cells releases large amounts of cellular contents into the bloodstream that results in hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia, which can lead to acute kidney injury, impaired organ function, and significant morbidity and mortality in pediatric and adult patients with cancer. Clinical consequences of TLS include cardiac arrhythmias, nausea, vomiting, renal failure, seizures, hyperuricemia, and disturbed electrolyte homeostasis (hyperkalemia, hyperphosphatemia, and hypocalcemia). The potential severity of these consequences and acute kidney injury can prevent the administration of life-prolonging or curative therapy and significantly impact patient outcomes. The main principles of TLS management involve the identification of patients at risk, initiation of prophylactic therapy in high-risk patients, and early recognition of and intervention for complications that arise in low- or intermediate-risk patients. The best available management strategy for TLS is prevention. As newer, more aggressive cytotoxic therapies are implemented to treat both hematologic and solid tumors, the incidence of TLS could increase and emerge in a broader spectrum of patients and malignancies. Therefore, it is critical for healthcare professionals to develop a complete understanding of TLS and its consequences.
After completing this activity, participants will be able to describe the pathophysiology of TLS and identify patient- and tumor-related characteristics that can be used to identify patients at risk for developing TLS. In addition, participants will review the safety and efficacy of hypouricemic agents that can provide optimal management for or prevent hyperuricemia and subsequent acute renal injury, and discuss considerations for using different prophylactic strategies in the management of pediatric and adult patients with different risk levels for TLS.

This activity is intended for hematologists, medical oncologists, oncology nurses, oncology physician assistants, nurse practitioners, fellows, and other healthcare professionals who manage patients with cancer who are at risk for TLS.

Upon completion of this activity, participants will be able to

1. Explain the pathophysiology of spontaneous or treatment-induced TLS and resulting clinical consequences that can cause significant morbidity and potential mortality in at-risk patients with cancer.
2. Summarize patient- and tumor-related characteristics that can be used to assign a level of risk to pediatric and adult patients who are predisposed to developing TLS and might require prophylaxis to prevent unnecessary morbidities.
3. Evaluate the safety and efficacy of hypouricemic agents that provide optimal management for or prevent hyperuricemia and subsequent acute renal injury in pediatric and adult patients with or at risk for TLS.
4. Discuss advantages and disadvantages of different prophylactic strategies that require consideration when managing pediatric and adult patients with high, intermediate, and low risk levels for TLS.

This interactive discussion/presentation will use multiple methods of participation, including case-based lectures, to engage attendees and enhance the learning process. 

Physicians: The CBCE™ (The Center for Biomedical Continuing Education) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The CBCE designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in this activity.

Physician Assistants: AAPA accepts certificates of participation for educational activities certified for Category 1 credit from AOACCME, Prescribed credit from AAFP, and AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hour of Category 1 credit for completing this program.

Nurses: The CBCE™ (The Center for Biomedical Continuing Education) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

The CBCE designates this educational activity for 1.0 contact hour.

Accreditation by the American Nurses Credentialing Center’s Commission on Accreditation refers to recognition of educational activities and does not imply approval or endorsement of any product.

The Evaluation and Request for Credit Form must be completed and returned to the CBCE following this activity to obtain credit. Please fill in the faculty name and date of the activity on the evaluation form. Participants will receive their certificate 4-6 weeks after the CBCE receives their form.

The CBCE gratefully acknowledges the educational grant provided by sanofi-aventis.  

The CBCE fully complies with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of support services, please notify the CBCE prior to the program. 

The content and views presented in this educational activity are those of the faculty and do not necessarily reflect the opinions or recommendations of the CBCE or sanofi-aventis. This material has been prepared based on a review of multiple sources of information but is not comprehensive. Participants are advised to critically appraise the information presented, and they are encouraged to consult the available literature on any product or device mentioned in this program.