Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome - An Evidence-Based Review

Oct 20, 2026

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Tumor lysis syndrome (TLS) has been categorized into laboratory and clinical forms with an established grading system, yet standardized, evidence-based guidelines are required to stratify patients by risk and define prophylaxis and treatment. A panel of experts in pediatric and adult hematologic malignancies reviewed relevant literature and clinical evidence to formulate recommendations. The guidance emphasizes prevention as best practice using hydration and rasburicase or allopurinol based on risk, plus monitoring, with established-TLS management including aggressive hydration, diuresis, and urate-lowering therapy.

LanguageEnglish

CategoryHealthcare

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Pages13

Reading Time33 min

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VOLUME 26 􀀁 NUMBER 16 􀀁 JUNE 1 2008 JOURNAL OF CLINICAL ONCOLOGY R E V I E W A R T I C L E From the Department of Hematology, Hospices Civils de Lyon and University Claude Bernard, Lyon, France; Division of Hematology/Oncology, Connecticut Children’s Medical Center, Hartford, CT; Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Division of Pediatric Hematology and Blood and Marrow Transplantation, Columbia University, New York, NY. Submitted October 24, 2007; accepted February 21, 2008 . Supported by an unrestricted educational grant from Sanoﬁ-aventis, the Pediatric Cancer Research Foundation (M.S.C.), and in part by Cancer Center Core Grant No. CA21765 and American Lebanese Syrian Associated Charities. Disclaimer: Many of the recommendations contained within these guidelines are based upon expert opinion and may differ from the dosages approved by the US Food and Drug Administration. Physicians are advised to read the package inserts for the drugs discussed in this article. Authors’ disclosures of potential conﬂicts of interest and author contributions are found at the end of this article. Corresponding author: Mitchell S. Cairo, MD, Division of Pediatric Blood and Marrow Transplantation, Columbia University, 3959 Broadway CHN 10-03, New York, NY 10032; e-mail: [mc1310@columbia.edu](mc1310@columbia.edu). © 2008 by American Society of Clinical Oncology 0732-183X/08/2616-2767/$20.00 DOI: 10.1200/JCO.2007.15.0177 Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome: An Evidence-Based Review Bertrand Coifﬁer, Arnold Altman, Ching-Hon Pui, Anas Younes, and Mitchell S. Cairo A B S T R A C T Purpose Tumor lysis syndrome (TLS) has recently been subclassiﬁed into either laboratory TLS or clinical TLS, and a grading system has been established. Standardized guidelines, however, are needed to aid in the stratiﬁcation of patients according to risk and to establish prophylaxis and treatment recommendations for patients at risk or with established TLS. Methods A panel of experts in pediatric and adult hematologic malignancies and TLS was assembled to develop recommendations and guidelines for TLS based on clinical evidence and standards of care. A review of relevant literature was also used. Results New guidelines are presented regarding the prevention and management of patients at risk of developing TLS. The best management of TLS is prevention. Prevention strategies include hydration and prophylactic rasburicase in high-risk patients, hydration plus allopurinol or rasburicase for intermediate-risk patients, and close monitoring for low-risk patients. Primary management of established TLS involves similar recommendations, with the addition of aggressive hydration and diuresis, plus allopurinol or rasburicase for hyperuricemia. Alkalinization is not recommended. Although guidelines for rasburicase use in adults are provided, this agent is currently only approved for use in pediatric patients in the United States. Conclusion The potential severity of complications resulting from TLS requires measures for prevention in high-risk patients and prompts treatment in the event that symptoms arise. Recognition of risk factors, monitoring of at-risk patients, and appropriate interventions are the key to preventing or managing TLS. These guidelines should assist in the prevention of TLS and improve the management of patients with established TLS. J Clin Oncol 26:2767-2778. © 2008 by American Society of Clinical Oncology INTRODUCTION Tumor lysis syndrome (TLS) is characterized by a group of metabolic derangements caused by the massive and abrupt release of cellular components into the blood after the rapid lysis of malignant cells.1 It is observed most frequently inpatients with hematologic malignancies such as acute lymphoblastic leukemia (ALL) and Burkitt’s lymphoma after the initiation

FAQs

What is tumor lysis syndrome (TLS) and why are guidelines needed?

TLS involves metabolic derangements caused by rapid lysis of malignant cells, leading to potentially severe complications. Guidelines are needed to stratify patients by risk and standardize prophylaxis and treatment recommendations.

How does the review recommend preventing TLS across different risk levels?

Prevention is emphasized as the best management approach. High-risk patients receive hydration plus prophylactic rasburicase; intermediate-risk patients receive hydration plus allopurinol or rasburicase; low-risk patients require close monitoring.

What is recommended for the treatment of established TLS and what is not recommended?

For established TLS, the guidance adds aggressive hydration and diuresis along with allopurinol or rasburicase for hyperuricemia. Alkalinization is not recommended.

Oct 20, 2026

Uploaded by Noah