Risk factors for TLS:
(1) tumor type (see below)
(2) high tumor burden (see below)
(3) significant pre-existing renal dysfunction
(4) baseline uric acid elevated (> 7.5 mg/dL (> 450 µmol/L)
(5) cytoreductive therapy that is rapid and effective in destroying tumor cells
Types of tumor associated with TLS:
(1) Burkitt's lymphoma
(2) lymphoblastic non-Hodgkin's lymphoma
(3) diffuse large cell non-Hodgkin's lymphoma
(4) acute leukemia
(5) solid tumor that is highly proliferative and highly responsive to cytoreductive therapy
where:
• The original listing in Table 4 for acute leukemia lists ALL only, but AML is also given in Table 5.
Evidence of high tumor burden:
(1) bulky tumor mass (maximum tumor diameter > 10 cm)
(2) elevated serum LDH (> 2 times upper limit of normal)
(3) leukemia AND white blood cell count > 25,000 per µL
