Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus
Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus
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DOI：
10.1111/j.1365-2141.2010.08143.x
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发表时间：
2010-05-01
影响因子：
6.5
通讯作者：
Younes, Anas
中科院分区：
文献类型：
--
作者：
Cairo, Mitchell S.;Coiffier, Bertrand;Younes, Anas
肿瘤溶解综合征（TLS）是一种危及生命的肿瘤急症，其特征是代谢异常，包括高尿酸血症、高磷血症、高钾血症和低钙血症。这些代谢并发症使癌症患者易于发生临床毒性，包括肾功能不全、心律失常、癫痫发作、神经系统并发症和潜在的猝死。随着新型治疗靶向药物（如拉布立海（重组尿酸氧化酶））的可用性增加，目前尚无针对有发生该综合征风险的个体患者的TLS风险分类的已发表指南。我们召集了一个国际TLS专家共识小组，制定医疗决策树指南，以将低、中、高风险分配给有TLS风险的癌症患者。风险因素包括实验室TLS（LTLS）的生物学证据、恶性肿瘤的增殖、体积和分期以及TLS诊断时的肾损害和/或受累。由儿科和成人肿瘤学家、TLS病理生理学专家以及TLS预防和管理专家组成的国际TLS共识专家小组制定了低、中和高风险TLS分类的最终模型以及相关TLS预防建议。
P>Tumour lysis syndrome (TLS) is a life-threatening oncological emergency characterized by metabolic abnormalities including hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia. These metabolic complications predispose the cancer patient to clinical toxicities including renal insufficiency, cardiac arrhythmias, seizures, neurological complications and potentially sudden death. With the increased availability of newer therapeutic targeted agents, such as rasburicase (recombinant urate oxidase), there are no published guidelines on the risk classification of TLS for individual patients at risk of developing this syndrome. We convened an international TLS expert consensus panel to develop guidelines for a medical decision tree to assign low, intermediate and high risk to patients with cancer at risk for TLS. Risk factors included biological evidence of laboratory TLS (LTLS), proliferation, bulk and stage of malignant tumour and renal impairment and/or involvement at the time of TLS diagnosis. An international TLS consensus expert panel of paediatric and adult oncologists, experts in TLS pathophysiology and experts in TLS prophylaxis and management, developed a final model of low, intermediate and high risk TLS classification and associated TLS prophylaxis recommendations.