Tumor Lysis Syndrome (TLS) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Cairo-Bishop classification
   Cairo-Bishop classification (laboratory/clinical TLS or high-risk)? (Most common after chemotherapy of high-burden hematologic malignancies (day 3 before to day 7 after). Laboratory TLS = ≥2 abnormalities or a 25% change from baseline: uric acid ≥476 µmol/L (8 mg/dL), potassium ≥6.0 mmol/L, phosphate ≥1.45 mmol/L (adults), calcium ≤1.75 mmol/L. Clinical TLS = laboratory TLS + one of: creatinine ≥1.5× ULN (AKI), arrhythmia/sudden death, seizure.)
   • Laboratory/clinical TLS → TLS → rescue
   • High-risk only, not yet TLS → High-risk prevention
2. [End] High-risk prevention
   Aggressive IV hydration to maintain urine output; allopurinol (xanthine oxidase inhibitor, prevents new uric acid only); monitor electrolytes, uric acid and renal function closely (every 4–6 h after chemotherapy). Routine urine alkalinization is no longer recommended.
3. [End] TLS → rescue
   1) Aggressive IV hydration, maintain high urine output. 2) Hyperuricemia → rasburicase 0.05–0.2 mg/kg IV (urate oxidase; contraindicated in G6PD deficiency). 3) Hyperkalemia → manage as hyperkalemia (most life-threatening). 4) Hyperphosphatemia → phosphate binders, avoid calcium (unless symptomatic hypocalcemia, to prevent calcium-phosphate deposition). 5) Hypocalcemia → replace calcium only if symptomatic, do not over-correct. 6) Refractory hyperkalemia/hyperphosphatemia, oliguric renal failure, fluid overload → renal replacement therapy (dialysis). Recheck electrolytes frequently.

Source guidelines & references

• Cairo MS, Bishop M. Tumour lysis syndrome classification. Br J Haematol 2004; Coiffier/Howard TLS management consensus

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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