Table 2.

Risk stratification definition and criteria

At high risk of developing tumor lysis syndrome are those patients who carry at least one of the following co-morbidities, disease-related or therapy-related factors
	Pediatric patients
Co-morbidities	- Renal impairment at diagnosis appear to be the only relevant co-morbidity in children - Kidney tumor involvement at onset - Hyperuricemia UA > 8 mg/dL
Disease-related factors	- Tumors with high proliferative rate - Bulky solid tumor especially if massive liver metastasis - Lympho-myeloproliferative disorders with large tumor burden as WBC > 50,000/mm3 or LDH > 2 times normal level - High grade lymphomas particularly Burkitt’s lymphoma and T-cell NHL - B-cell and T-cell acute lymphoblastic leukemias
Treatment-related factors	- Intensive cytoreductive chemotherapy in hematologic malignancies
	Adult patients
Co-morbidities	- Dehydratation - Hyponatriemia - Pre-existing renal impairment including tumor infiltration that reduce renal function - Obstructive uropathy - Hyperuricemia UA > 10 mg/dL
Disease-related factors	- Tumors with high proliferative rate - Bulky solid tumor especially if massive liver metastasis - Lympho-myeloproliferative disorders with large tumor burden such as > 50,000/mm3 or LDH > 2 times normal level - Advanced germ cell lung cancer - High grade lymphomas particularly Burkitt’s lymphoma, a T-cell NHL - B-cell acute lymphoblastic leukemias
Treatment-related factors	- Intensive cytoreductive chemotherapy in hematologic malignancies

Abbreviations: LDH, lactate dehydrogenase; NHL, non-Hodgkin lymphoma; UA, uric acid; WBC, white blood cell.