Table 4.

Treatment of laboratory tumor lysis syndrome (LTLS and clinical tumor lysis syndrome (CTLS)

	Laboratory TLS 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 - Urine alkalinization NaHCO3 50–70 mEq/L to maintain urinary pH > 7 - Furosemide if urine volume is <100 mL/m2/h or 3 mL/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
Clinical TLS pediatric patients
- 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. - Consider hemodialysis.
Laboratory and clinical TLS adult patients
There is no major differences in treatment of laboratory and clinical TLS in adult patients
- Rasburicase 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. - Low dose dopamine can be used to improve renal perfusion. - Consider hemodialysis.

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