# Tumour lysis syndrome: risk assessment, prophylaxis and treatment

Source: https://onco.cc/protocols/tumour-lysis-syndrome-prevention-and-treatment/  
OnCo record `tumour-lysis-syndrome-prevention-and-treatment` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When a fast-growing cancer such as some leukaemias and lymphomas is first treated, many cancer cells can die at once and flood the blood with potassium, phosphate and uric acid, which can damage the kidneys and heart. Teams check who is at risk, give extra fluids and a medicine (allopurinol, or rasburicase for higher risk) before treatment, and check blood tests often in the first days.

## Summary

TLS is laboratory (two or more of raised uric acid, potassium or phosphate, or low calcium, by 25% from baseline or past fixed thresholds, from three days before to seven days after starting treatment) or clinical (laboratory TLS with renal failure, arrhythmia or seizure) (Italian consensus 2008). Risk rises with bulky or highly chemosensitive disease (Burkitt and lymphoblastic lymphoma, acute lymphoblastic leukaemia, bulky small cell lung cancer), LDH over twice normal, pre-existing renal impairment, dehydration and high uric acid. The Cairo 2010 expert panel assigns low, intermediate and high risk with a decision tree.

Prevention (Cairo 2008): close monitoring for low risk, hydration with allopurinol or rasburicase for intermediate risk, hydration with prophylactic rasburicase for high risk. The Italian consensus gives low-risk patients oral allopurinol and hydration and high-risk patients rasburicase 0.20 mg/kg/day over 30 minutes as inpatients, starting at least 4 hours before treatment and continuing 3 to 5 days, without allopurinol at the same time; rasburicase is contraindicated in G6PD deficiency and methaemoglobinaemia. Hydration ideally starts 48 hours ahead, keeping urine output at least 100 mL an hour in adults. Monitor LDH, uric acid, sodium, potassium, creatinine, urea, phosphate and calcium every 12 hours for 3 days in high-risk patients.

Established TLS: hydration and rasburicase, observations and electrolytes every 6 hours for the first 24 hours, calcium only for symptomatic hypocalcaemia, and renal replacement for persistent hyperkalaemia, severe acidosis, refractory overload or uraemia. Cairo 2008 does not recommend urine alkalinisation; the Italian consensus keeps it only for low-risk patients and those who cannot have rasburicase. The BSH 2015 guideline could not be read.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: TLS prophylaxis; tumor lysis syndrome management; rasburicase or allopurinol; laboratory TLS; clinical TLS; Cairo-Bishop
- Tags: protocol; acute-oncology; oncological-emergency; metabolic

## Connected records

- technologies: [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- drugs: [Allopurinol](https://onco.cc/drugs/allopurinol/), [Rasburicase](https://onco.cc/drugs/rasburicase/), [Venetoclax](https://onco.cc/drugs/venetoclax/)
- terms: [Tumour lysis syndrome (TLS)](https://onco.cc/terms/tumor-lysis-syndrome/), [Tumour lysis syndrome in lymphoma: who is at risk, and rasburicase](https://onco.cc/terms/lymphoma-tx-tumour-lysis/)
- protocols: [Hyperleukocytosis and leukostasis in acute leukaemia: supportive care, cytoreduction and leukapheresis](https://onco.cc/protocols/hyperleukocytosis-leukostasis/)

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