Study Identifies Risk Factors for Tumor Lysis Syndrome in Non-Hodgkin Lymphoma

Tumor lysis syndrome (TLS) is a serious complication that can occur during treatment in people with non-Hodgkin lymphoma (NHL). It happens when cancer cells break down quickly and release substances into the blood. A study presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting identified factors linked to a higher risk of TLS in hospitalized patients with NHL. 

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The impact of tumor lysis syndrome on patients

Researchers reviewed data from 350,400 hospital stays involving adults with NHL between 2016 and 2020. TLS was uncommon. It occurred in less than 1% of hospitalizations. 

Even though TLS was rare, it had a major impact on patients. TLS can cause symptoms such as fever, chills, nausea, vomiting, confusion, shortness of breath, dark or cloudy urine, and unusual fatigue. If it is not treated quickly, it can lead to kidney damage or kidney failure, an irregular heartbeat, seizures, and other serious complications. 

In the study, people with TLS stayed in the hospital longer, averaging 10 days compared with 6 days for patients without TLS. They also had higher healthcare costs. 

Bone marrow involvement increased risk

One of the strongest risk factors was bone marrow involvement. Bone marrow is the soft tissue inside bones where blood cells are made. Lymphoma can sometimes spread to the bone marrow. 

Researchers found that patients with bone marrow involvement were much more likely to develop TLS.

This finding suggests that people who have lymphoma in the bone marrow may need closer monitoring surrounding treatment. 

Changes in blood chemistry were warning signs

Several blood test abnormalities were strongly linked to TLS. These included:

• High potassium levels
• High phosphate levels
• Low calcium levels

These changes can happen when large numbers of cancer cells break down. Doctors already monitor these laboratory values when TLS is a concern. 

Infection and low blood counts also increased risk

Researchers found several other factors linked to TLS. These included:

• Sepsis, a serious infection
• Neutropenia, a low level of infection-fighting white blood cells
• HIV infection
• Receiving chemotherapy during the hospital stay

Patients with these risk factors were more likely to develop TLS than patients without them.

Prior treatment was linked to a lower risk

Some factors were linked to a lower risk of TLS.

Patients who had received chemotherapy in the past were less likely to develop TLS. Prior radiation therapy was also linked to a lower risk.

The researchers believe TLS risk may be highest when people first begin treatment or when they have a large amount of lymphoma in their body.

Helping prevent a serious complication

Tumor lysis syndrome (TLS) is a medical emergency, but it can often be prevented or managed when doctors identify patients at higher risk. This study found that having lymphoma in bone marrow, certain blood test abnormalities, infections, and low blood counts were linked to a greater risk of TLS. 

Understanding these risk factors may help healthcare teams decide who needs extra monitoring, fluids, or preventive medicines before treatment begins. Talk with your lymphoma specialist about your risk of developing TLS.

Source: 

• Predictors of tumor lysis syndrome in non-Hodgkin lymphoma hospitalizations