How is tumor lysis syndrome prevented in patients with Burkitt lymphoma/Burkitt-like lymphoma (BL/BLL)?

Updated: Dec 20, 2019
  • Author: Ali H Kanbar, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Maintain adequate hydration through intravenous (IV) fluids, ideally starting 24 hours before administering chemotherapy. Note, however, that many patients require chemotherapy emergently and, in these patients, therapy should not be delayed.

Maintain high urine outflow (200-250 mL/m2/h), and monitor renal function closely.

Most patients with Burkitt lymphoma are considered at high risk for tumor lysis and meet the criteria for upfront treatment with rasburicase, which should be administered at a dose of 0.20 mg/kg IV daily for 5 days. Note that patients receiving rasburicase should not have alkalinization of the urine and that this agent is contraindicated in patients with glucose-6-phospate deficiency (G6PD). Lower-risk patients and those who cannot tolerate rasburicase can receive allopurinol, 300 mg twice daily

Close monitoring of the complete blood cell (CBC) count, coagulation studies, and at least twice-daily measurement of serum uric acid, potassium, calcium, phosphorus, magnesium, and creatinine levels is necessary for the first several days of treatment. Consider placing the patient on a cardiac monitor for the first few days. Liver function results should also be monitored.

Treatment should be performed at a facility where renal dialysis is available should it be necessary, particularly for patients with extensive disease.


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