背景:肿瘤溶解综合征(TLS),自发发生或响应抗癌治疗,导致细胞内钾的释放,磷,和核酸进入血液,导致可能致命的继发性临床并发症。先前的TLS指南没有考虑到有效的新型肿瘤药物或具有TLS风险增加的现代治疗范式。因此,我们召集了一个修改后的Delphi专家小组,根据支持性文献和实践共识,对TLS管理指南进行了更新.
方法:实施了三轮修改的Delphi过程。在第1轮中,九名专家小组成员完成了使用已发表文献开发的基于网络的问卷。在第2轮中,小组成员被要求重新考虑他们对未达成共识的问题的答案(定义为投票小组成员之间≥66%的同意)。第3轮是无盲的,主持虚拟会议,讨论任何尚未达成共识的剩余问题。
结果:给出了预防的详细建议,监测,以及TLS风险和并发症的管理,水合作用是TLS预防和管理的关键要素。TLS急性影响的管理和长期肾脏影响的预防指南包括高钾血症的管理,低钙血症,高磷酸盐血症,和高尿酸血症。
结论:尽管目前可用的药物控制尿酸水平相当有效,小组成员强调监测和治疗其他危险的电解质异常如高钾血症和高磷血症的重要性。此修改后的Delphi小组指南应帮助临床医生预防和管理TLS。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.