Closing out his discussion on tumor lysis syndrome, Anthony Perissinotti, PharmD, BCOP, shares practical advice on its identification and management.
Anthony Perissinotti: Patients that are at high risk for tumor lysis really need to be admitted to the hospital for very close monitoring. We need to get labs every 6 hours, maybe every 8. If you ask our pediatric colleagues they want to get labs every 4 hours. Obviously, there is limitations in how fast you’re going to get your labs back and being able to address those labs. In our practice we usually use q [every] 8 hours but that being said, you can’t do every 8 hour labs as an outpatient. So patients need to be admitted.
Contrast that to our intermediate or lower risk, many of these patients don’t need laboratory monitoring that closely and can be monitored as an outpatient. Definitely low-risk patients are monitored as an outpatient. Intermediate risk—it depends on which expert you ask and which guidelines you look at, but in our practice our intermediate-risk patients are treated as an outpatient. Just to give you a picture of what an intermediate-risk patient looks like, this would be a patient getting R-CHOP [rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone] for diffuse large B-cell lymphoma. As you know, we don’t admit every single one of those patients for q-8 hour laboratory monitoring of tumor lysis. We are monitoring these patients as an outpatient.
I think the most important thing to know about tumor lysis syndrome is that it is a life-threatening syndrome. So we all need to be educated about it, whether you’re at an academic center treating hundreds of patients per year, or at a community center treating only a couple patients that are at risk for tumor lysis per year. I think it’s very important to have institutional guidelines that outlines who is at high risk, who needs labs very frequently, what labs should we be ordering for these patients, what are the signs and symptoms, what prevention strategies should we be using and what treatment strategies should we be using? This should all be outline in an institutional guideline so that we have a uniform practice no matter who is treating this patient. Whether it’s oncologist X or oncologist Z, or the interns with PharmD’s who are treating the patients. I think everyone needs a uniform approach and a common strategy so that we’re not recreating the wheel every single time we have a new patient with tumor lysis. Also, when you treat in a uniform fashion and standardize the approach it’s going to be safer for the patient.
Transcript edited for clarity.