Tumor lysis syndrome primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]

Overview

Effective measures for the primary prevention of tumor lysis syndrome include allopurinol, rasburicase, and intravenous hydration.

Before initiating chemotherapy for cancer patients, especially lymphomas and leukemias, patients should receive the following:^[1]


Patient population	Treatment

Low risk	Adequate intravenous hydration to maintain a high urine output (> 2.5 L/day) Alkalinization of urine is not recommended.^[2]
Intermediate risk	Allopurinol Adults dosing: 200-400mg/m2/day in 1-3 divided doses; maximum dose is 800mg/day Infants weighing less than 10kg: 3.3mg/kg every 8 hours
High risk	Rasburicase 0.2mg/kg for 5-7 days A single dose of 3 mg may be used in high risk patients Contraindicated in patients with glucose 6 phosphate dehydrogenase (G6PD) deficiency

↑ Jones, Gail L; Will, Andrew; Jackson, Graham H; Webb, Nicholas J A; Rule, Simon (2015). “Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology”. British Journal of Haematology. 169 (5): 661–671. doi:10.1111/bjh.13403. ISSN 0007-1048.
↑ Ten Harkel AD, Kist-Van Holthe JE, Van Weel M, Van der Vorst MM (1998). “Alkalinization and the tumor lysis syndrome”. Med Pediatr Oncol. 31 (1): 27–8. PMID 9607427.