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

被引：4

作者：

Perissinotti, Anthony J. ^{[1
]}

Bishop, Michael R. ^{[2
]}

Bubalo, Joseph ^{[3
]}

Geyer, Mark B. ^{[4
]}

Goodrich, Amy ^{[5
]}

Howard, Scott C. ^{[6
]}

Kula, Julianna ^{[7
]}

Mandayam, Sreedhar ^{[8
]}

Cairo, Mitchell S. ^{[9
,11
]}

Pui, Ching-Hon ^{[10
,12
]}

机构：

[1] Univ Michigan Hlth, Dept Pharm, Michigan Med, Ann Arbor, MI 48109 USA

[2] Univ Chicago Med, David & Etta Jonas Ctr Cellular Therapy, Chicago, IL 60637 USA

[3] OHSU Hosp & Clin, Dept Pharm, Pharm Serv, Div Hematol & Med Oncol, Portland, OR 97239 USA

[4] Mem Sloan Kettering Canc Ctr, Dept Med, Leukemia & Cell Therapy Serv, New York, NY 10021 USA

[5] Johns Hopkins Kimmel Canc Ctr, Baltimore, MD 21231 USA

[6] Univ Tennessee, Hlth Sci Ctr, Memphis, TN 38103 USA

[7] Rocky Mt Canc Ctr, Greenwood Village, CO USA

[8] Univ Texas MD Anderson Canc Ctr, Dept Nephrol, Houston, TX 77030 USA

[9] New York Med Coll, Canc & Blood Dis Ctr, Dept Pediat, Valhalla, NY 10595 USA

[10] St Jude Childrens Res Hosp, Dept Oncol Global Pediat Med & Pathol, Memphis, TN 38105 USA

[11] 40 Sunshine Cottage Rd,Skyline 1N-D12, Valhalla, NY 10595 USA

[12] St Jude Childrens Res Hosp, 262 Danny Thomas Pl, Memphis, TN 38105 USA

来源：

CANCER TREATMENT REVIEWS | 2023年 / 120卷

关键词：

Tumor lysis syndrome; Cancer; Acute kidney injury; Hyperuricemia; Hyperkalemia; ACUTE-LYMPHOBLASTIC-LEUKEMIA; ACUTE MYELOID-LEUKEMIA; ACUTE KIDNEY INJURY; HIGH-RISK; XANTHINE NEPHROPATHY; 1ST-LINE TREATMENT; RENAL-FAILURE; URIC-ACID; CHILDREN; RASBURICASE;

D O I：

10.1016/j.ctrv.2023.102603

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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 & GE; 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.

引用

页数：10