Guidelines for Complications of Cancer Treatment Vol VIII Part B

1. Guidelines for the management of pediatric andadult tumor lysis syndrome: an evidence- basedreview.Coiffier B, Altman A, Pui CH, et al J Clin Oncol. 2008;26:2767-78.PURPOSE: Tumor lysis syndrome (TLS) has recently beensubclassified into either laboratory TLS or clinical TLS, anda grading system has been established. Standardizedguidelines, however, are needed to aid in the stratification ofpatients according to risk and to establish prophylaxis andtreatment recommendations for patients at risk or withestablished TLS. METHODS: A panel of experts in pediatricand adult hematologic malignancies and TLS was assembledto develop recommendations and guidelines for TLS basedon clinical evidence and standards of care. A review of relevantliterature was also used. RESULTS: New guidelines arepresented regarding the prevention and management of patientsat risk of developing TLS. The best management of TLS isprevention. Prevention strategies include hydration andprophylactic rasburicase in high-risk patients, hydration plusallopurinol or rasburicase for intermediate-risk patients, andclose monitoring for low-risk patients. Primary managementof established TLS involves similar recommendations, withthe addition of aggressive hydration and diuresis, plusallopurinol or rasburicase for hyperuricemia. Alkalinizationis not recommended. Although guidelines for rasburicase usein adults are provided, this agent is currently only approvedfor use in pediatric patients in the United States.CONCLUSION: The potential severity of complicationsresulting from TLS requires measures for prevention in highriskpatients and prompts treatment in the event that symptomsarise. Recognition of risk factors, monitoring of at-risk patients,and appropriate interventions are the key to preventing ormanaging TLS. These guidelines should assist in the prevention436