Patients at high risk of tumour lysis syndrome (TLS) require a structured, proactive clinical approach. This protocol addresses the specific interventions, monitoring, and escalation steps indicated in this risk setting.
This protocol applies to patients identified as being at high risk of tumour lysis syndrome. In this setting, intravenous hydration should be considered, along with prophylactic use of rasburicase. Ongoing blood test monitoring determines whether further escalation is required.
When biochemical or clinical signs of TLS emerge on subsequent monitoring, the protocol calls for escalation to a treatment-level rasburicase approach. Patients previously managed on allopurinol or febuxostat are switched to rasburicase at this stage.
DOI: 10.1111/bjh.70092
Patients with high risk of TLS: consider intravenous hydration. Consider prophylactic rasburicase, 3 mg may be sufficient but may need to be repeated depending on blood tests.
We recommend the use of rasburicase for patients at high risk of TLS, or in those who are at intermediate risk and cannot take xanthine oxidase inhibitors, or in whom immediate therapy is required and pre-existing urate levels are high.
If a patient develops clinical TLS on subsequent monitoring, then they should be treated as having established TLS, which includes increasing the dose of rasburicase to 0.2 mg/kg/day for up to 7 days in adults or switching to rasburicase if patients were previously on either allopurinol/febuxostat.
Escalating rasburicase to treatment dose should also be used for patients who develop biochemical signs of TLS on subsequent monitoring.
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