Table 3 TLS risk assessment and management with venetoclax [48, 74,75,76].
From: First-line treatment for CLL in the era of targeted therapy
Risk group | Criteria | Management |
|---|---|---|
Low | All lymph nodes <5 cm and ALC < 25 × 109/l | Prophylaxis: Allopurinol 2–3 d prior to venetoclax intake; rasburicase if uric acid is elevated Hydration: Oral (1.5–2 l/d from 2 d prior to dose ramp-up) Hospitalization: Outpatient, check TLS parameters and CrCl at least 6–8 h and 24 h after each ramp-up step |
Intermediate | Any lymph node 5–10 cm or ALC ≥ 25 × 109/l | Prophylaxis: Allopurinol 2–3 d prior to venetoclax intake; rasburicase if uric acid is elevated Hydration: Oral or intravenous Hospitalization: Outpatient, check TLS parameters and CrCl at least 6–8 h and 24 h after each ramp-up step or inpatient if pre-existing abnormalities or relevant coexisting conditions (CrCl <80 ml/min) |
High | Any lymph node ≥10 cm or Any lymph node ≥5 cm and ALC ≥ 25 × 109/l | Prophylaxis: Rasburicase 2–3 d prior to venetoclax intake Hydration: Oral and intravenous Hospitalization: Admission to an inpatient or day hospital with intensified laboratory monitoring |
