What to follow in Tumor Lysis Syndrome?

From the Guidelines

Tumor Lysis Syndrome management should focus on hydration and uric acid reduction, with rasburicase recommended for high-risk patients and allopurinol for low-risk patients.

Key Recommendations

• Hydration is crucial in preventing and managing Tumor Lysis Syndrome (TLS), with a goal of at least 2 L/m2/day of fluid administration 1.
• Rasburicase is recommended for high-risk patients, administered at a dose of 0.20 mg/kg/day, infused over 30 minutes, starting at least four hours before tumor-specific therapy and continuing for at least 3-5 days 1.
• Allopurinol is recommended for low-risk patients, administered orally at a dose of 100 mg/m2 thrice daily (maximum 800 mg/day) 1.
• Urine alkalinization is not recommended for patients receiving rasburicase therapy, unless other clinical conditions require it 1.
• Loop diuretics may be required to maintain urine output, but should be used with caution in patients with obstructive uropathy or hypovolemia 1.

Patient Risk Stratification

• High-risk patients should receive rasburicase and hydration in an inpatient setting, with close monitoring and ready access to intensive care unit facilities if needed 1.
• Low-risk patients can receive oral allopurinol, hydration, and urine alkalinization, with a watch-and-wait approach and close monitoring 1.
• Intermediate-risk patients may require a combination of hydration, allopurinol, and rasburicase, with a case-by-case decision based on the patient's condition 1.

From the Research

Prevention and Management of Tumor Lysis Syndrome

To prevent and manage Tumor Lysis Syndrome (TLS), the following strategies can be employed:

• Aggressive hydration to prevent dehydration and reduce the risk of acute renal failure 2, 3, 4, 5, 6
• Control of hyperuricemia using allopurinol and rasburicase treatment to prevent uric acid nephropathy and renal insufficiency 2, 3, 4, 5, 6
• Close monitoring of electrolyte abnormalities, such as hyperkalemia, hyperphosphatemia, and secondary hypocalcemia, to prevent life-threatening complications 2, 3, 4, 5, 6
• Identification of patients at risk for TLS, including those with high-grade lymphomas, acute lymphoblastic leukemia, and other rapidly proliferating tumors 2, 3, 4, 5, 6
• Multidisciplinary collaboration and communication to ensure prompt recognition and management of TLS 3, 6
• Meticulous nursing care, including prevention and treatment of TLS, to critical to patient survival 3

Key Considerations

• TLS can occur after any type of neoplasm, but is highly associated with rapidly proliferating tumors 4, 5, 6
• Initiation of chemotherapy, radiotherapy, or steroid treatment may trigger TLS, or it may develop spontaneously 4, 5
• The release of massive quantities of intracellular contents can produce hyperkalemia, hyperphosphatemia, secondary hypocalcemia, hyperuricemia, and acute renal failure 2, 3, 4, 5, 6
• Prevention and treatment measures, including intravenous hydration, use of allopurinol and rasburicase, management of TLS-associated electrolyte abnormalities, and renal replacement therapy, can help manage TLS 2, 3, 4, 5, 6