
High Risk (>5% risk TLS)
- Burkitt lymphoma / leukaemia with LDH level ≥2 x ULN
- ALL with WBC ≥100 X 109/L or serum LDH ≥2 x ULN
- AML, WBC ≥100 X 109/L
- Any intermediate/aggressive lymphoma with bulky tumour mass and serum LDH > the ULN
- Patients with otherwise intermediate risk disease but with baseline renal dysfunction, or uric acid, potassium, or phosphate levels above the ULN
Prophylaxis:
- Check baseline creatinine, phosphate, urate, calcium, LDH.
- Aggressive fluids 2-3 L/m2/day to achieve a urine output of 80-100 mL/m2/hour.
- Rasburicase 3 mg IV single dose.
- Recheck blood tests at 4-6 hours and repeat rasburicase if urate is still elevated.
Note: Rasburicase is expensive. Discuss with consultant.
Topic Code: 6619