Tumor lysis syndrome: A clinical review

Table 1 Cairo-Bishop definition of laboratory tumor lysis syndrome for adults

Variable	Value	Change from baseline value
Uric acid	≥ 8 mg/dL (476 mmol/L)	25% increase
Potassium	≥ 6.0 mEq/L (or 6 mmol/L)	25% increase
Phosphorus	≥ 4.5 mg/dL (1.45 mmol/L) for adults and ≥ 6.5 mg/dL (2.1 mmol/L) for children	25% increase
Calcium	≤ 7 mg/dL (1.75 mmol/L)	25% decrease

Adapted from Cairo et al[2].

Table 2 Cairo-Bishop grading of clinical tumor lysis syndrome for adults

Variable	Grade 0	Grade I	Grade II	Grade III	Grade IV	Grade V
Creatinine	None	1.5 times ULN. Rise in creatinine is not attributable to chemotherapeutic agent(s)	> 1.5-3.0 times ULN. Rise in creatinine is not attributable to chemotherapeutic agent(s)	> 3.0-6.0 times ULN. Rise in creatinine is not attributable to chemotherapeutic agent(s)	> 6.0 times ULN. Rise in creatinine is not attributable to chemotherapeutic agent(s)	Death
Cardiac arrhythmia	None	Intervention not indicated	Nonurgent medical intervention indicated. Cardiac arrhythmias not attributable to chemotherapeutic agent(s)	Symptomatic and incompletely controlled medically or controlled with device (e.g., defibrillator). Cardiac arrhythmias not attributable to chemotherapeutic agent(s)	Life-threatening (e.g., arrhythmia associated with HF, hypotension, syncope, shock). Cardiac arrhythmias not attributable to chemotherapeutic agent(s)	Death
Seizures	None	-	One brief, generalized seizure; seizure(s) well controlled by anticonvulsants or infrequent focal motor seizures not interfering with ADL	Seizure in which consciousness is altered; poorly controlled seizure disorder; with breakthrough generalized seizures despite medical intervention	Seizure of any kind which are prolonged, repetitive or difficult to control (e.g., status epilepticus, intractable epilepsy)	Death

Adapted from Cairo et al[2]. ADL: Activities of daily living; HF: Heart failure; ULN: Upper limits of normal.