Table 3.
Malignancies in which TLS prophylaxis is recommended due to the risk of TLS [2, 24, 25]
| Low TLS risk Most solid tumors [24, 25] • Non-small cell lung cancer • Breast cancer • Ovarian cancer • Vulvar cancer • Prostate cancer • Renal cell cancer • Hepatocellular cancer • Adenocarcinoma of the gastrointestinal tract • Malignancies • Rhabdomyosarcoma • Thymoma CLL and Lc <50 × 109/L treated with alkylating agents AML and Lc <25 × 109/L and LDH increase to <2× ULN MM CML Indolent NHL ALCL |
Intermediate TLS risk Solid tumors with high tumor burden, advanced tumor stage, and high chemosensitivity • Small-cell lung cancer • Germ cell tumors • Neuroblastoma CLL treated with fludarabine, rituximab or lenalidomide or venetoclax and LN >5 cm or absolute lymphocyte count >25 × 109/L and/or Lc >50 × 109/L AML and Lc 25–100 × 109/L AML and Lc <25 × 109/L and LDH increase to >2× ULN T-cell leukemia/lymphoma, diffuse large B-cell lymphoma, and mantle cell lymphoma, each with low tumor burden and elevated LDH and ALL and Lc <100 × 109/L and LDH increase to <2× ULN Burkitt's lymphoma and LDH increase to <2× ULN Lymphoblastic lymphoma stage I/II and LDH increase <2× ULN |
High TLS risk Malignancies with intermediary risk and renal insufficiency Malignancy with intermediary risk and elevated serum parameters uric acid, potassium, and/or phosphate CLL treated with venetoclax and LN >10 cm or LN >5 cm absolute lymphocyte count >50 × 109/L and elevated uric acid AML and Lc 100 × 109/L T-cell leukemia/lymphoma, diffuse large B-cell lymphoma, and mantle cell lymphoma with high tumor burden and LDH increase >2× ULN ALL and Lc >100 × 109/L and/or LDH increase >2× ULN Burkitt's lymphoma stage III/IV and/or LDH increase >2× ULN Burkitt leukemia Lymphoblastic lymphoma stage III/IV and/or LDH increase >2× ULN |
CML, chronic myeloid leukemia; MM, multiple myeloma; CLL, chronic lymphocytic leukemia; AML, acute myeloid leukemia; ALCL, anaplastic large cell lymphoma; ALL, acute lymphocytic leukemia; Lc, leukocytes; LN, lymph nodes; NHL, non-Hodgkin lymphoma.