Overview of prophylaxis and treatment for tumor lysis syndrome (TLS)

G6PD: glucose-6-phosphate dehydrogenase; HLA: human leukocyte antigen; TLS: tumor lysis syndrome.

¶ As examples of risk stratification, most solid tumors are low risk, with exceptions including certain highly chemotherapy-sensitive solid tumors with bulky or advanced disease (eg, neuroblastoma, germ cell tumor, small cell lung cancer). Risk stratification of hematologic malignancies depends on factors described in the algorithm and related UpToDate content.

Δ Refer to related UpToDate content for choice and volume of hydration fluid to maintain adequate urine output.

◊ Rasburicase should not be used in patients with G6PD deficiency; in patients who experienced severe hemolysis, methemoglobinemia, or anaphylaxis with prior rasburicase treatment; or in patients who have high risk for those reactions. Refer to related UpToDate content for dosing and schedule of administration, G6PD testing, and emergency use if rasburicase is required but the risk of rasburicase is uncertain.

§ Caution is advised with allopurinol in patients with HLA-B*58:01 allele (more common in those with Han Chinese, Thai, or Korean ancestry) due to risk for severe cutaneous adverse reactions. Refer to related UpToDate content for allopurinol dosing, drug-drug interactions, hypersensitivity reactions, increased risk for xanthine crystal deposition in kidneys, and alternative hypouricemic agents.

¥ Management may include methods to correct metabolic disorders and/or kidney replacement therapy, as described in related UpToDate material.