Guidelines for Complications of Cancer Treatment Vol VIII Part B

and should have ready access to rasburicase as well as intensivecare unit facilities if his or her clinical condition deteriorates.Allopurinol may be stopped and resumed at cessation ofrasburicase. A renal expert should be notified regarding thepatient in case dialysis is required. (level of evidence: II;grade of recommendation: A).Intermediate-risk patients:For intermediate-risk pediatric patients, in addition tohydration, allopurinol may be used as an initialantihyperuricemic treatment as described in allopurinolAdministration. Initial management with a single dose ofrasburicase might also be considered in pediatric patients withevidence of urate nephropathy (renal dysfunction). (level ofevidence: V; grade of recommendation: D).Low-risk:For pediatric patients unlikely to develop TLS, a watch-andwaitapproach with close monitoring is appropriate (level ofevidence: V; grade of recommendation: D). The aboverecommendations are valid for adult patients (level ofevidence: V; grade of recommendation: B).Table 1. Cairo-Bishop Definition of Laboratory TumorLysis SyndromeElement Value Change From BaselineUric acid 476 μmol/L or 8 mg/dL 25% increasePotassium 6.0 mmol/L or 6 mg/L 25% increasePhosphorus 2.1 mmol/L for children or 25% increase1.45 mmol/L for adultsCalcium 1.75 mmol/L 25% decreaseNOTE. Two or more laboratory changes within 3 days before or 7 daysafter cytotoxic therapy.430