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Review
. 2023 Nov:120:102603.
doi: 10.1016/j.ctrv.2023.102603. Epub 2023 Aug 6.

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

Anthony J Perissinotti  1 , Michael R Bishop  2 , Joseph Bubalo  3 , Mark B Geyer  4 , Amy Goodrich  5 , Scott C Howard  6 , Julianna Kula  7 , Sreedhar Mandayam  8 , Mitchell S Cairo  9 , Ching-Hon Pui  10
Affiliations
Review

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

Anthony J Perissinotti et al. Cancer Treat Rev. 2023 Nov.

Abstract

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 ≥ 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.

Keywords: Acute kidney injury; Cancer; Hyperkalemia; Hyperuricemia; Tumor lysis syndrome.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AJP reports consulting fees from AbbVie, BeiGene, Pfizer, Sanofi-Aventis, and Servier. MRB serves as a member on an advisory board or as a consultant for Autolus Therapeutics, BMS/JUNO Therapeutics, Chimeric Therapeutics, CRISPR Therapeutics, IN8bio, Incyte, Iovance Biotherapeutics, KITE/Gilead, Novartis, PhysIQ, and Sana Biotechnology and is on the speakers’ bureau for ADC Therapeutics, Agios, BMS, Kite/Gilead, Incyte, Sanofi, and Servier. JB reports consulting fees from Sanofi-Aventis. MBG reports research support from Actinium Pharmaceuticals, Amgen, and Sanofi and has served on an advisory board for Sanofi and as a consultant for Novartis. AG reports consulting fees from Sanofi-Aventis. SCH has served as a speaker for Jazz Pharma and Sanofi, has received grant funding from Jazz Pharma, and has served as a consultant for Servier. JK reports consulting fees from Sanofi-Aventis. SM reports grant funding from Horizon; service on advisory boards for Calliditas, Chinook, Travere, and US Renal Care; and service on speaker’s bureaus for Bayer and Calliditas. MSC serves on the speaker’s bureau and as a consultant for Sanofi. C-HP reports support by grant CA21765 from the National Cancer Institute and American Lebanese Syrian Associated Charities, and honorarium from Amgen and Novartis.

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