Incidence of chemotherapy-related tumour lysis syndrome at Kenyatta National Hospital, Nairobi

Abstract

Objectives: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. Design: Prospective patient-treatment cohort study. Setting: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. Subjects: One hundred and forty two patients receiving first course chemotherapy. Main Outcome measure: Laboratory defined Tumour Lysis Syndrome (TLS). Results: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non- haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. Conclusions: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.