Spontaneous Tumor Lysis Syndrome

Clinical Presentation and Diagnosis

The American Society of Clinical Oncology recommends that spontaneous tumor lysis syndrome (TLS) be considered in patients with high tumor burden, rapid proliferation rates, or highly chemosensitive malignancies, even without treatment 1, 2
The Cairo-Bishop classification system explicitly accounts for TLS occurring "3 days before or 7 days after the initiation of treatment," recognizing that TLS can develop before therapy begins 1, 2
Laboratory TLS is defined by two or more abnormal serum values (uric acid, potassium, phosphate, or calcium) at presentation 1, 2
Non-Hodgkin lymphoma (NHL) is one of the highest-risk malignancies for TLS development, with incidence rates of 19.6% for hyperuricemia and 6.1% for TLS in NHL patients 1

The most likely immediate cause of death was cardiac arrhythmia or sudden cardiac death from severe hyperkalemia 2, 3
Elevated potassium levels produce "cardiac irregularities such as arrhythmias, ventricular tachycardia, fibrillation, or cardiac arrest" 2

The American Society of Clinical Oncology recommends immediate risk stratification upon NHL diagnosis, before any treatment, and initiating aggressive hydration (≥2 L/m²/day) and prophylactic rasburicase or allopurinol in high-risk patients, ideally 48 hours before chemotherapy 3, 4
Monitoring electrolytes, uric acid, and renal function at least daily in newly diagnosed NHL patients, even before treatment begins, is crucial for early detection and prevention of TLS 3, 4