Perissinotti Anthony J, Bishop Michael R, Bubalo Joseph, Geyer Mark B, Goodrich Amy, Howard Scott C, Kula Julianna, Mandayam Sreedhar, Cairo Mitchell S, Pui Ching-Hon
University of Michigan Health - Michigan Medicine, Department of Pharmacy, Ann Arbor, MI 48109, USA.
The David and Etta Jonas Center for Cellular Therapy, University of Chicago Medicine, Chicago, IL 60637, USA.
Cancer Treat Rev. 2023 Nov;120:102603. doi: 10.1016/j.ctrv.2023.102603. Epub 2023 Aug 6.
Tumor lysis syndrome (TLS), which occurs spontaneously or in response to anticancer treatment, results in the release of intracellular potassium, phosphorus, and nucleic acids into the bloodstream, which results in secondary clinical complications that may be fatal. Prior TLS guidelines do not take into consideration potent novel oncologic agents or contemporary treatment paradigms with increased risk of TLS. Thus, a modified Delphi panel of experts was convened to provide an update for TLS management guidelines based upon a combination of supporting literature and practice consensus.
A three-round modified Delphi process was implemented. For round 1, nine expert panelists completed a web-based questionnaire developed using published literature. In round 2, panelists were asked to reconsider their answers to questions that did not reach consensus (defined as ≥ 66% agreement among voting panelists). Round 3 was an unblinded, moderated virtual meeting to discuss any remaining questions that did not reach consensus.
Detailed recommendations are given for prophylaxis, monitoring, and management of TLS risks and complications, with hydration being a key element of TLS prophylaxis and management. Guidelines for the management of acute effects of TLS and prevention of long-term renal effects include management of hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia.
Although the control of uric acid levels is quite effective with currently available agents, panelists emphasize the importance of monitoring and treating other dangerous electrolyte abnormalities such as hyperkalemia and hyperphosphatemia. Guidelines from this modified Delphi panel should aid clinicians in preventing and managing TLS.
肿瘤溶解综合征（TLS）可自发发生或因抗癌治疗而引发，导致细胞内钾、磷和核酸释放到血液中，进而引发可能致命的继发性临床并发症。既往的TLS指南未考虑到强效新型肿瘤药物或具有更高TLS风险的当代治疗模式。因此，召集了一个经过改良的德尔菲专家小组，根据支持性文献和实践共识为TLS管理指南提供更新。
实施了三轮改良的德尔菲法。在第一轮中，九位专家小组成员完成了一份基于已发表文献编制的网络问卷。在第二轮中，要求小组成员重新考虑他们对未达成共识的问题（定义为投票小组成员中≥66%的一致意见）的回答。第三轮是一次无盲法、有主持人的虚拟会议，讨论任何仍未达成共识的剩余问题。
针对TLS风险和并发症的预防、监测及管理给出了详细建议，水化是TLS预防和管理的关键要素。TLS急性效应管理及长期肾脏效应预防指南包括高钾血症、低钙血症、高磷血症和高尿酸血症的管理。
尽管目前可用药物对尿酸水平的控制相当有效，但小组成员强调监测和治疗其他危险电解质异常（如高钾血症和高磷血症）的重要性。这个经过改良的德尔菲专家小组制定的指南应有助于临床医生预防和管理TLS。
