TY - JOUR
T1 - Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States
T2 - Results of a modified Delphi panel
AU - Perissinotti, Anthony J.
AU - Bishop, Michael R.
AU - Bubalo, Joseph
AU - Geyer, Mark B.
AU - Goodrich, Amy
AU - Howard, Scott C.
AU - Kula, Julianna
AU - Mandayam, Sreedhar
AU - Cairo, Mitchell S.
AU - Pui, Ching Hon
N1 - Funding Information:
Funding for the study was provided by Sanofi. The sponsor was not involved in the administration of the questionnaires, data collection, or analysis. Sponsor representatives attended the phase 3 virtual meeting as silent observers.
Publisher Copyright:
© 2023
PY - 2023/11
Y1 - 2023/11
N2 - 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.
AB - 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.
KW - Acute kidney injury
KW - Cancer
KW - Hyperkalemia
KW - Hyperuricemia
KW - Tumor lysis syndrome
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U2 - 10.1016/j.ctrv.2023.102603
DO - 10.1016/j.ctrv.2023.102603
M3 - Review article
C2 - 37579533
AN - SCOPUS:85167793578
SN - 0305-7372
VL - 120
JO - Cancer treatment reviews
JF - Cancer treatment reviews
M1 - 102603
ER -