Criteria

Laboratory TLS: two or more of uric acid 8 mg/dL or more, potassium 6 mmol/L or more, phosphate 4.5 mg/dL or more (6.5 in children) or calcium 7 mg/dL or less, or a 25% change from baseline, from 3 days before to 7 days after starting treatment ^[1]. Clinical TLS: laboratory TLS plus creatinine 1.5 times the upper limit or more, arrhythmia or sudden death, or seizure ^[1].

Risk groups and prevention (summary) ^{[2, 3]}

Risk	Examples	Prevention
High	Burkitt and lymphoblastic lymphoma, ALL with WBC 100,000/µL or more, AML with WBC 100,000/µL or more, bulky disease with high LDH	Aggressive hydration and rasburicase; monitoring in a high-dependency unit
Intermediate	AML with WBC 25,000–100,000/µL, DLBCL with high LDH, CLL starting venetoclax with bulky nodes or high lymphocytosis	Hydration and allopurinol; labs every 8–12 hours
Low	Most solid tumours, myeloma, CML	Hydration and monitoring; allopurinol as needed

Rasburicase and G6PD

Rasburicase is contraindicated in G6PD deficiency (haemolysis and methaemoglobinaemia); in high-risk patients of African, Mediterranean, Middle Eastern or Asian ancestry, test before giving it if time allows ^[3]. Urine alkalinisation is no longer recommended ^[2].

References

3 references

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Numbers in the text, such as ^[1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

1
Tumour lysis syndrome: new therapeutic strategies and classificationCairo MS, Bishop M · Br J Haematol · 2004;127:3-11
DOI PubMed Back to text: 1 2
2
Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based reviewCoiffier B, Altman A, Pui CH, et al · J Clin Oncol · 2008;26:2767-78
DOI PubMed Back to text: 1 2
3
The tumor lysis syndromeHoward SC, Jones DP, Pui CH · N Engl J Med · 2011;364:1844-54
DOI PubMed Back to text: 1 2

This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/tools/tumor-lysis-syndrome-criteria/

Tumour Lysis Syndrome: Cairo-Bishop Criteria and Prevention

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