Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: Results of a modified Delphi panel

Authors

Anthony J. Perissinotti, University of Michigan Health - Michigan Medicine, Department of Pharmacy, Ann Arbor, MI 48109, USA.
Michael R. Bishop, The David and Etta Jonas Center for Cellular Therapy, University of Chicago Medicine, Chicago, IL 60637, USA.
Joseph Bubalo, Department of Pharmacy/Division of Hematology and Medical Oncology, OHSU Hospital and Clinics, Pharmacy Services, Portland, OR 97239, USA.
Mark B. Geyer, Leukemia and Cell Therapy Services, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Amy Goodrich, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA.
Scott C. Howard, University of Tennessee Health Sciences Center, Memphis, TN 38103, USA.
Julianna Kula, Rocky Mountain Cancer Centers, Greenwood Village, CO 80112, USA.
Sreedhar Mandayam, Department of Nephrology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Mitchell S. Cairo, Department of Pediatrics, Cancer and Blood Diseases Center, New York Medical College, Valhalla, NY 10595, USA. Electronic address: Mitchell_Cairo@nymc.edu.Follow
Ching-Hon Pui, Departments of Oncology, Global Pediatric Medicine, and Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA. Electronic address: Ching-Hon.Pui@STJUDE.ORG.

Author Type(s)

Faculty

DOI

10.1016/j.ctrv.2023.102603

Journal Title

Cancer Treatment Reviews

First Page

102603

Document Type

Article

Publication Date

11-1-2023

Department

Pediatrics

Abstract

INTRODUCTION: Tumor lysis syndrome (TLS), which occurs spontaneously or in response to anticancer treatment, results in the release of intracellular potassium, phosphorus, and nucleic acids into the bloodstream, which results in secondary clinical complications that may be fatal. Prior TLS guidelines do not take into consideration potent novel oncologic agents or contemporary treatment paradigms with increased risk of TLS. Thus, a modified Delphi panel of experts was convened to provide an update for TLS management guidelines based upon a combination of supporting literature and practice consensus. METHODS: A three-round modified Delphi process was implemented. For round 1, nine expert panelists completed a web-based questionnaire developed using published literature. In round 2, panelists were asked to reconsider their answers to questions that did not reach consensus (defined as ≥ 66% agreement among voting panelists). Round 3 was an unblinded, moderated virtual meeting to discuss any remaining questions that did not reach consensus. RESULTS: Detailed recommendations are given for prophylaxis, monitoring, and management of TLS risks and complications, with hydration being a key element of TLS prophylaxis and management. Guidelines for the management of acute effects of TLS and prevention of long-term renal effects include management of hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia. DISCUSSION: Although the control of uric acid levels is quite effective with currently available agents, panelists emphasize the importance of monitoring and treating other dangerous electrolyte abnormalities such as hyperkalemia and hyperphosphatemia. Guidelines from this modified Delphi panel should aid clinicians in preventing and managing TLS.

Recommended Citation

Perissinotti, A. J., Bishop, M. R., Bubalo, J., Geyer, M. B., Goodrich, A., Howard, S. C., Kula, J., Mandayam, S., Cairo, M. S., & Pui, C. (2023). Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: Results of a modified Delphi panel. Cancer Treatment Reviews, 120, 102603. https://doi.org/10.1016/j.ctrv.2023.102603