Guidelines for Complications of Cancer Treatment Vol VIII Part B

The relative risk of developing TLS is significantly higher inpatients with high uric acid levels (8 mg/dL) and highphosphorus levels.Clinical manifestations: The clinical features of TLS mayinclude nausea, vomiting, diarrhea, anorexia, lethargy, edema,fluid overload, hematuria, congestive heart failure, cardiacdysrhythmias, seizures, muscle cramps, tetany, syncope, andpossible sudden death. Although symptoms may occur beforethe start of chemotherapy, they are observed more commonlywithin 12 to 72 hours after the initiation of cytoreductivetherapy. Complications resulting from TLS can compromisethe efficacy or further administration of chemotherapy.ClassificationThere is currently no universally accepted system forclassification and grading. The most recent and preferred isCairo and Bishop classification system based on defininglaboratory or clinical TLS (LTLS or CTLS). This systemdistinguishes between patients who do not require therapeuticintervention versus those experiencing life-threatening clinicalabnormalities.This classification and grading system is currently being usedby Children’s Oncology GroupUnder this system, LTLS is considered to be present if levelsof two or more serum values of uric acid, potassium, phosphate,or calcium are more than or less than normal at presentationor if they change by 25% within 3 days before or 7 days afterthe initiation of treatment (Table 1). CTLS requires thepresence of LTLS in addition to one or more of the followingsignificant clinical complications: renal insufficiency, cardiacarrhythmias/ sudden death, and seizures (Table 2). LTLS isconsidered to be either present or absent (Table 1), whereas421