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Risk evaluation, prophylaxis, and treatment of tumor lysis syndrome: Consensus of an Italian expert panel

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Abstract

Introduction

Tumor lysis syndrome (TLS) is a life-threatening complication in patients with hematological disease and/or solid tumors that results from rapid, large-scale tumor necrosis occurring spontaneously, or more commonly, as a result of chemotherapy. TLS is characterized by metabolic and electrolyte imbalances that include hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Identification of risk groups as well as early detection of TLS is crucial for the establishment of appropriate strategies of prophylaxis and treatment.

Methods

A review of the peer-reviewed literature on TLS between 1990 and 2011 was conducted via a systematic search of the PubMed database using the keywords “TLS” [AND] “management,” “risk evaluation,” “prophylaxis,” and “treatment.” An expert opinion-based approach was used to review the national and international recommendations and guidelines on the topic.

Results

The PubMed search produced 90 results, all of which were evaluated. These studies, together with a recent international consensus panel provided recommendations for evaluating the risk of TLS and providing prophylaxis. Five algorithms are presented that consider all of the factors when assessing the risk for neoplastic disease in general, and specifically for leukemia and lymphoma.

Conclusion

The present report provides clinicians with an easily consultable tool to guide the evidence-based management of this oncohematological emergency.

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Authors and Affiliations

  1. Pediatric Oncology and Hematology “Lalla Seràgnoli“, Ospedale Sant’Orsola-Malpighi, Policlinico S. Orsola-Malpighi, Azienda Ospedaliera-Universitaria di Bologna, Pediatric Unit, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy

    Andrea Pession & Riccardo Masetti

  2. Division of Hematology, Department of Clinical and Experimental Medicine & CRIFF, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy

    Gianluca Gaidano

  3. Division of Hematology, Ospedale Civile Infermi, Rimini, Italy

    Patrizia Tosi

  4. Oncology Unit, Ospedale Regionale, Treviso, Italy

    Giovanni Rosti

  5. Department of Medical Oncology, Institute for Cancer Research and Treatment (IRCC), University of Turin Medical School, Turin, Italy

    Massimo Aglietta

  6. Department of Hematology, University of Bari, Bari, Italy

    Giorgina Specchia

  7. Department of Pediatric, University of Brescia, Spedali Civili di Brescia, Brescia, Italy

    Fulvio Porta

  8. A.F. di Ematologia, Dipartimento di Biochimica e Biotecnologie Mediche, Università di Napoli Federico II Ceinge Biotecnologie Mediche, Napoli, Italy

    Fabrizio Pane

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  1. Andrea Pession
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  2. Riccardo Masetti
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  3. Gianluca Gaidano
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  8. Fulvio Porta
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  9. Fabrizio Pane
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Corresponding author

Correspondence to Andrea Pession.

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Pession, A., Masetti, R., Gaidano, G. et al. Risk evaluation, prophylaxis, and treatment of tumor lysis syndrome: Consensus of an Italian expert panel. Adv Therapy 28, 684–697 (2011). https://doi.org/10.1007/s12325-011-0041-1

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  • DOI: https://doi.org/10.1007/s12325-011-0041-1

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