This protocol addresses patients assessed as being at intermediate risk of tumour lysis syndrome (TLS). This risk category requires careful, individualised assessment: while some patients in this group can be managed with a standard preventive approach, others may have a clinical profile that warrants escalation to a high-risk strategy.
Patients at intermediate risk must be considered on a case-by-case basis, as the appropriate level of intervention varies depending on individual clinical factors.
Management for intermediate-risk patients centres on a preventive strategy combining adequate hydration with a urate-lowering agent, initiated ahead of definitive cancer-directed therapy. Certain patients unable to tolerate the first-line urate-lowering approach have alternative agents available within the protocol.
The full protocol details the specific agents, dosing by patient type, timing requirements, and the criteria that should prompt escalation — access it below.
DOI: 10.1111/bjh.70092
Patients with intermediate risk of TLS: Oral hydration and allopurinol may be sufficient for these patients but must be considered on a case-by-case basis, as some may warrant a strategy as per high-risk patients (2C).
Allopurinol can be considered in those with low or intermediate risk of TLS. This should be started at least 12 h prior to definitive therapy.
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.
View source ↗