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Tumour lysis syndrome in blood cancer: what it is and how it is prevented | CION Cancer Clinics
Tumour lysis syndrome happens when treatment breaks down many cancer cells at once and the kidneys cannot clear what spills out. It is usually prevented with extra fluids, uric acid-lowering medicine and frequent blood tests in the first days. Very little urine, cramps, an uneven heartbeat or confusion after starting leukaemia or lymphoma treatment needs the emergency department or 108 now. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is tumour lysis syndrome, and can it be prevented?
- Who is most likely to get it?
- How is it prevented in the first days of treatment?
- Which blood results does the team watch?
- What do families often misunderstand about it?
- What can this page not tell you, and what should you ask?
- Common questions about tumour lysis syndrome
!
If this is happening now
If someone has just started treatment for leukaemia or lymphoma and is passing very little urine, has muscle cramps or twitching, a racing or uneven heartbeat, confusion or a fit, go to the nearest emergency department now or call 108. Say they have just started blood cancer treatment. Do not wait for the next clinic visit, and do not give extra medicines or large amounts of salt water at home first.
The short answer
What is tumour lysis syndrome, and can it be prevented?
Tumour lysis syndrome happens when treatment kills a large number of cancer cells very quickly and their contents flood the blood. It is usually prevented with plenty of fluids, medicines that lower uric acid and frequent blood tests in the first days of treatment.
Why breaking cancer cells can be a danger
Each cancer cell holds potassium, phosphate and material that turns into uric acid. When millions break open at once, the kidneys cannot clear it fast enough. High potassium can upset the heartbeat. Uric acid and phosphate can form crystals that block the kidneys. Calcium can then drop, which causes cramps and, rarely, fits.
When it usually happens
It most often starts within the first few days after the first treatment, while the cancer is at its largest. Occasionally it begins even before treatment, in very fast-growing cancers. Once the bulk of the disease has come down, the risk falls sharply.
What prevention means in practice
For you, prevention mostly looks like a drip, a lot of drinking, measuring every drop of urine and blood being taken more often than you expect. It can feel like a lot of fuss before the real treatment. It is that fuss that keeps the kidneys and heart safe.
Not sure whether this applies to you?
Ask an oncologistHigher risk
Who is most likely to get it?
The team rates your risk before the first dose. These are the things that push it up.
Fast-growing cancers
Cancers whose cells divide quickly break down quickly under treatment. That puts some cancers at the top of the list.
Most often seen in
- Burkitt lymphoma
- Acute lymphoblastic leukaemia
- Acute myeloid leukaemia with a high count
A large amount of disease
A very high white cell count, a big mass in the chest or tummy, or enlarged liver and spleen all mean more cells can break at once.
Kidneys already under strain
If the kidneys were weak before, or you are dehydrated from vomiting, loose motions or poor intake, there is less room to clear the load.
Strong, fast-acting treatment
Intensive chemotherapy, steroids in some leukaemias, and some newer targeted drugs such as venetoclax can clear cells quickly. With venetoclax, doses are raised slowly for exactly this reason.
Slow-growing cancers carry a much lower risk, but it is not zero.Step by step
How is it prevented in the first days of treatment?
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Blood tests before the first dose
Kidney function, potassium, phosphate, calcium, uric acid and an enzyme called LDH are checked. These set the starting point everything else is compared with.
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Fluids through a drip
You are given extra fluid, often starting before treatment, to keep the kidneys flushing. The team weighs you and measures urine to make sure the fluid is coming out, not building up.
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A medicine to lower uric acid
Allopurinol, a tablet, stops new uric acid forming. For higher risk, rasburicase, given in a drip, breaks down uric acid already present. Rasburicase is not safe for people with G6PD deficiency, an inherited condition that is fairly common in India, so a test may be done first.
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Frequent checks
Blood is taken several times a day at first in higher-risk patients. A heart tracing may be done if potassium rises.
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Acting early if levels climb
Medicines can move potassium out of the blood. If the kidneys cannot keep up, dialysis may be needed for a short time, usually until the kidneys recover.
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On your report
Which blood results does the team watch?
- Potassium
- A salt that controls the heartbeat. Too much is the most urgent danger in this syndrome.
- Phosphate
- Released from broken cells. A high level can damage the kidneys and pull calcium down.
- Uric acid
- A waste product that can form crystals in the kidneys.
- Calcium
- Often falls as phosphate rises. Low calcium causes cramps and tingling around the mouth.
- Creatinine
- Shows how well the kidneys are filtering. A rising level means they are struggling. Reference ranges differ between laboratories, and the team reads each result against the earlier ones.
Commonly believed
What do families often misunderstand about it?
"Kidney trouble this early means the treatment is failing."
Usually it means the opposite: the treatment is breaking down cancer cells quickly. The problem is the speed, and the team manages it while treatment carries on where it is safe to.
"All those blood tests are just the hospital being careful for no reason."
Changes in potassium can happen within hours and give no warning until the heart is affected. The tests catch it before you feel anything.
"Drinking less water will stop the constant trips to the toilet."
Passing plenty of urine is how the kidneys wash the load out. Cutting back makes crystals more likely. Tell the nurse if drinking is hard, rather than quietly drinking less.
"Once we are home, it cannot happen."
The risk is highest in the first days, but some tablet treatments started as an outpatient carry it too. Know the warning signs before you leave.
Being straight with you
What can this page not tell you, and what should you ask?
This page cannot tell you your own risk. That depends on the exact type of blood cancer, how much disease there is, your kidney function and the treatment chosen. Only the treating team, with your blood results in front of them, can rate it.
Having tumour lysis syndrome does not settle the outlook
Most people who develop it are treated and continue their cancer treatment. Some need a short spell of dialysis and their kidneys recover. It says nothing on its own about how the cancer will respond.
Questions worth asking
Ask what your risk level is and why. Ask how often blood will be taken, whether a G6PD test is planned, and what signs should make you call once you are home. Ask whether the centre can arrange dialysis quickly if it is needed, or where you would be moved. At CION, the haematology team discusses each case at a tumour board and coordinates care with qualified centres when a higher level of care is needed.
Never change fluids, tablets or treatment timing on your own. The treating team sets all of it.Questions we are asked
Common questions about tumour lysis syndrome
How soon after chemotherapy can tumour lysis syndrome start?
It usually starts within the first few days after treatment begins, which is why checks are closest together then. In very fast-growing cancers it can begin before any treatment is given. Your team will tell you how long you need close monitoring for your own treatment.
Can it be fatal?
Untreated, it can be very serious, because high potassium can stop the heart and the kidneys can fail. That is exactly why prevention and frequent blood tests are built into the first days. When it is caught early and treated, most people come through it and carry on with their cancer treatment.
Why does my father need a drip if he can drink water?
The amount of fluid needed is often more than a person can comfortably drink, especially when feeling sick. A drip gives steady, measured fluid day and night. The team still wants him to drink if he can, and will tell you how much and what to record.
What is the G6PD test and why does it matter here?
G6PD deficiency is an inherited condition where red cells break down when exposed to some medicines. Rasburicase, a medicine used to lower uric acid fast, can trigger that. Because the condition is not rare in India, many teams test for it first when rasburicase is being considered.
Will dialysis be permanent?
In most people who need it for this reason, dialysis is short term and the kidneys recover as the salts settle. Recovery can take longer if the kidneys were weak before treatment. The team will explain what they expect in your case and review it as results improve.
Should we avoid certain foods during this time?
The team may ask you to limit foods high in potassium or phosphate while levels are being watched, such as coconut water, bananas or packaged foods. Ask for a written list, because advice depends on your results. Do not start fasts or special diets without asking.
Does it happen with every blood cancer?
No. It is far more common with fast-growing leukaemias and lymphomas and with a large amount of disease. Slow-growing conditions carry a lower risk, although certain targeted medicines raise it. Your team decides how much prevention you need from your own results.
Can treatment still go ahead if levels rise?
Often yes, after the salts are brought back under control. Sometimes the next dose is delayed or the plan adjusted. That decision belongs to the treating haematologist, who weighs the risk to the kidneys against the need to keep treating the cancer.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Definition of tumor lysis syndrome
- Cancer Research UK — Side effects of chemotherapy
- Leukemia & Lymphoma Society — Side effect management
- Cancer.Net — Managing physical side effects
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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