Table 3.

Prevention of tumor lysis syndrome

	Pediatric patients
Low risk	- Allopurinol orally 300 mg/m2/day or 10 mg/kg/day 3 times. - However a single dose of rasburicase will be take into account for also low-risk patients - Hyperhydratation with glucosaline or normal saline solution 2.5–3 L/m2/day or 200 mL/kg/day if children <10 kg - Alkalinization NaHCO3 50–70 mEq/L to maintain urinary pH > 7 - Furosemide if urine volume is < 100 mL/m2/h or 3mL/kg/h for children <10 kg
High risk	- Rasburicase 0.2 mg/kg/day at least 4 hours before beginning chemotherapy for 3–5 days - Hyperhydratation with glucosaline or normal saline solution 2.5–3 L/m2/day or 200 mL/kg/day if children <10 kg - Furosemide if urine volume is <100 mL/m2/h or 3 mL/kg/h for children <10 kg
	Adult patients
Low risk	- Allopurinol orally 300 mg/m2/day 3 times - Hyperhydratation 2.5–3 L/m2/day with glucosaline or normal saline solution. Hydratation should always be performed, except in patients at risk of rapid volume overload - Alkalinization to maintain urine pH > 7 - Furosemide or mannitol if urine volume is <100 mL/m2/h. Diuretics should be administered unless hypovolemia or obstructive uropathy are diagnosed to maintain urine outputof at least 100 mL/m2/h with urinary specific gravity ≤1010
High risk	- Rasburicase 0.05–0.2 mg/kg/day for 3–5 days - Hyperhydratation 2.5–3 L/m2/day with glucosaline or normal saline solution. Hydratation should always be performed, except in patients at risk of rapid volume overload - Furosemide or mannitol if urine volume is <100 mL/m2/h. Diuretics should be administered unless hypovolemia or obstructive uropathy are diagnosed to maintain urine output of at least 100 mL/m2/h with urinary specific gravity ≤1010 - For solid tumors reduced chemotherapy schedule may be evaluated to reduce tumor burden and related TLS risk

Rasburicase is contraindicated in patients with metahemoglobinemia, G6PD deficiency or other metabolic disorders that may cause hemolitic anemia.