Tumor lysis syndrome Prophylaxis Risk stratification Evaluate the risk of risk of TLS in all patients who are due to receive chemotherapy for a hematological malignancy. B Primary prophylaxis Low risk patients Q Is the patient at low risk of tumor lysis syndrome? Yes Monitor fluid status and laboratory results carefully in patients at low risk of TLS, and use a low threshold to initiate intravenous fluids and consider allopurinol if needed. B No Primary prophylaxis Intermediate risk patients Q Is the patient at intermediate risk of tumor lysis syndrome? Yes Administer allopurinol prophylaxis along with increased hydration in patients at intermediate risk of TLS, and continue prophylaxis for up to 7 days or until risk of TLS has resolved. B No Primary prevention High risk patients Q Does the patient have G6PD deficiency? Yes Offer prophylaxis with rasburicase along with increased hydration in patients at high risk of TLS. B Avoid using allopurinol in combination with rasburicase, as it may reduce the efficacy of this drug. D No Avoid rasburicase in patients with G6PD deficiency; treat such patients with intravenous fluids, allopurinol, and close monitoring. D