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: National referral & teaching hospital, KNH; 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 nonhaematological
malignancies was 3.6%. Hyperphosphataemia and hyperkalemia 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 fifty-five percent resolved in the first week. Two TLS case
mortalities occurred.
Conclusions: The incidence of TLS in this cohort study is 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.