Cairo-Bishop clinical tumor lysis syndrome definition* and grading

Complication	Grade
Complication	0	1	2	3	4	5
Creatinine^¶^Δ	≤1.5 × ULN	1.5 × ULN	>1.5-3.0 × ULN	>3.0-6.0 × ULN	>6.0 × ULN	Death
Cardiac arrhythmia^¶	None	Intervention not indicated	Nonurgent medical intervention indicated	Symptomatic and incompletely controlled medically or controlled with device (eg, defibrillator)	Life-threatening (eg, arrhythmia associated with HF, hypotension, syncope, shock)	Death
Seizure^¶	None	–	One brief, generalized seizure; seizure(s) well controlled by antiseizure medications or infrequent focal motor seizures not interfering with ADL	Seizure in which consciousness is altered; poorly controlled seizure disorder; with breakthrough generalized seizures despite medical intervention	Seizure of any kind which are prolonged, repetitive or difficult to control (eg, status epilepticus, intractable epilepsy)	Death

ULN: upper limit of normal; HF: heart failure; ADL: activities of daily living.
* Clinical tumor lysis syndrome defined as laboratory tumor lysis syndrome plus at least one clinical complication.
¶ Not directly or probably attributable to therapeutic agent.
Δ If no institutional ULN is specified, age/sex ULN creatinine may be defined as follows: >1 to <12 years of age, both male and female, 61.6 mmol/L; ≥12 to <16 years, both male and female, 88 mmol/L; ≥16 years, female 105.6 mmol/L, male 114.4 mmol/L.

Reproduced with permission from: Coiffier B, Altman A, Pui CH, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26:2767. Copyright © 2008 American Society of Clinical Oncology. All rights reserved.

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Cairo-Bishop clinical tumor lysis syndrome definition* and grading