Characterization of Clinical Interventions for the Prevention of Tumour Lysis Syndrome in Intermediate- to High-Risk Hematologic Malignancy: A Multi-Site Retrospective Chart Review
CCCF ePoster library. McKenna S. Nov 8, 2018; 233412
Disclosure(s): Nothing to disclose
Sarah McKenna
Sarah McKenna
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Abstract
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Background: Tumour Lysis Syndrome (TLS) occurs when lysis of malignant cells causes electrolyte disturbances and potentially organ dysfunction. Guidelines recommend preventive therapy based on TLS risk, but are based on low-quality evidence.

Objectives: The primary objective was to characterize utilization of TLS preventive strategies; secondary objectives included determining TLS incidence, comparing use of preventive rasburicase and intravenous (IV) sodium bicarbonate among intermediate-risk (IR) and high-risk (HR) subjects, and describing TLS treatment strategies.

Methods: Retrospective chart review of newly-diagnosed malignant hematology patients admitted to an oncology centre and/or affiliated intensive care unit between October 2015 and September 2016 in Ontario, Canada.

Results: Fifty-eight subjects were eligible for inclusion (29 IR, 29 HR). Use of preventive allopurinol, intravenous bicarbonate, and furosemide was similar between groups. Rasburicase was more frequently used in HR subjects (3% IR vs. 36% HR, p = 0.003). Fourteen percent (n = 4) of IR and 8% (n = 2) of HR subjects developed TLS during admission. TLS was observed in 10% of subjects who received preventive rasburicase vs. 11% of subjects who did not (p = 1.00), and in 9% of subjects who received preventive IV bicarbonate vs. 25% of subjects who did not (p = 0.219). TLS treatment strategies included rasburicase, IV bicarbonate, furosemide, and renal replacement therapy.

Conclusion: In this retrospective chart review, rasburicase was more commonly used in HR subjects while use of other agents was similar between groups. This pattern of use is inconsistent with guidelines, which recommend that all patients at HR of TLS receive rasburicase. There was no difference in TLS incidence between subjects who received preventive rasburicase or IV bicarbonate and those who did not. Further prospective studies are needed to inform management of patients with malignancies at IR or HR of TLS.


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