Consensus conference on the management of tumor lysis syndrome
Consensus conference on the management of tumor lysis syndrome
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DOI：
10.3324/haematol.13290
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发表时间：
2008-12-01
期刊：
影响因子：
--
通讯作者：
Tura, Sante
中科院分区：
文献类型：
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作者：
Tosi, Patrizia;Barosi, Giovanni;Tura, Sante
肿瘤溶解综合征是癌症中大量细胞溶解的潜在危及生命的并发症。确定高危患者和及早识别综合征对于制定适当的治疗方案至关重要。作用于尿酸代谢为尿囊素的药物，如别嘌呤醇或拉布立酶，可有效预防和治疗肿瘤溶解综合征。合理的建议应规范临床环境中的诊断和药物应用。本文报告了共识会议项目期间发布的关于肿瘤溶解综合征管理的建议，并得到了意大利血液学会（SIE），意大利儿科肿瘤学家协会（AIEOP）和意大利医学肿瘤学会（AIOM）的认可。由8位专家组成的小组对肿瘤溶解综合征的病理生理学、临床特征和治疗的当前概念进行了评估。然后，根据小组讨论的相关性标准，就肿瘤溶解综合征管理的关键问题达成共识。水化和拉布立酶应给予肿瘤特异性治疗的候选人和肿瘤溶解综合征的高风险的成年癌症患者。肿瘤溶解综合征低风险的癌症患者应在口服别嘌呤醇的同时接受水化沿着治疗。患有临床肿瘤溶解综合征的患者以及发生实验室肿瘤溶解综合征的成人和高危儿童也应给予水合和拉布立酶。总之，专家组根据药物疗效特征，推荐拉布立酶用于选定患者的肿瘤溶解综合征预防。需要进行方法上严格的研究，以澄清其成本效益情况。
Tumor lysis syndrome is a potentially life threatening complication of massive cellular lysis in cancers. Identification of high-risk patients and early recognition of the syndrome is crucial in the institution of appropriate treatments. Drugs that act on the metabolic pathway of uric acid to allantoin, like allopurinol or rasburicase, are effective for prophylaxis and treatment of tumor lysis syndrome. Sound recommendations should regulate diagnosis and drug application in the clinical setting. The current article reports the recommendations on the management of tumor lysis syndrome that were issued during a Consensus Conference project, and which were endorsed by the Italian Society of Hematology (SIE), the Italian Association of Pediatric Oncologists (AIEOP) and the Italian Society of Medical Oncology (AIOM). Current concepts on the pathophysiology, clinical features, and therapy of tumor lysis syndrome were evaluated by a Panel of 8 experts. A consensus was then developed for statements regarding key questions on tumor lysis syndrome management selected according to the criterion of relevance by group discussion. Hydration and rasburicase should be administered to adult cancer patients who are candidates for tumor-specific therapy and who carry a high risk of tumor lysis syndrome. Cancer patients with a low-risk of tumor lysis syndrome should instead receive hydration along with oral allopurinol. Hydration and rasburicase should also be administered to patients with clinical tumor lysis syndrome and to adults and high-risk children who develop laboratory tumor lysis syndrome. In conclusion, the Panel recommended rasburicase for tumor lysis syndrome prophylaxis in selected patients based on the drug efficacy profile. Methodologically rigorous studies are needed to clarify its cost-effectiveness profile.