Tumor Lysis Syndrome: Narrative Review of Risk Stratification and Management

The quick death of cancer cells causes tumor lysis syndrome (TLS), a life-threatening oncologic emergency that results in the release of intracellular components like potassium. nucleic acids and phosphate into the systemic circulation. Hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia are all produced by this cascade, and if they are not identified and treated right away, they can lead to arrhythmias, seizures, acute kidney injury, and even death. This review synthesizes data from PubMed, Embase, Web of Science, and the Cochrane Library, concentrating on clinical studies, randomized trials, retrospective analyses, and meta-analyses that were published between 2000 and 2025. According to research, the risk of TLS depends on the kind of tumor, the patient's profile, and the course of therapy. Rasburicase has consistently demonstrated superiority over allopurinol among pharmacological treatments for quickly lowering uric acid in adults and children, particularly in those at high risk. Febuxostat has proven non-inferior to allopurinol, making it a viable option when allopurinol is contraindicated. Cost-effective approaches, such as singledose rasburicase protocols, have become popular in resource-constrained environments. Rasburicase is the preferred treatment for high-risk instances, while allopurinol and febuxostat are still suitable for patients with low-to intermediate risk. Ultimately, accurate risk stratification, early intervention, And increasing the availability of successful treatments is still essential for lowering the incidence and death associated with TLS.