TLS risk categories and prophylactic measures for venetoclax-based treatment in CLL
| Assessments before treatment . | TLS risk category . | Risk parameters . | Mitigation measures . | ||
|---|---|---|---|---|---|
| Prophylactic medication . | Hydration . | Hospitalization . | |||
| Tumor burden assessment | Low | All lymph nodes <5 cm AND ALC <25 × 109/L | 2-3 d before venetoclax intake: allopurinol In cases of elevated uric acid: rasburicase | Oral hydration (1.5-2 L/d), starting 2 d before dose ramp up. | Outpatient, check TLS parameters and creatinine clearance at least 6 to 8 h and 24 h after each ramp up step |
| CT scan | |||||
| Lymphocyte count | |||||
| Blood chemistry | Medium | Any lymph node 5-10 cm OR ALC ≥ 25 × 109/L | Oral hydration or consider IV hydration | Outpatient, check TLS parameters and creatinine clearance at least 6 to 8 h and 24 h after each ramp up step OR inpatient, in case of preexisting abnormalities or relevant coexisting conditions (creatinine clearance <80 mL/min) | |
| Potassium | |||||
| Phosphate | |||||
| Calcium | |||||
| Uric acid | |||||
| Renal function | High | Any lymph node ≥10 cm OR Any lymph node ≥ 5 cm AND ALC ≥ 25 × 109/L | Oral hydration AND intravenous hydration | Admission to an inpatient or day hospital to ensure sufficient IV hydration and TLS monitoring | |
| Creatinine clearance | |||||
| Assessments before treatment . | TLS risk category . | Risk parameters . | Mitigation measures . | ||
|---|---|---|---|---|---|
| Prophylactic medication . | Hydration . | Hospitalization . | |||
| Tumor burden assessment | Low | All lymph nodes <5 cm AND ALC <25 × 109/L | 2-3 d before venetoclax intake: allopurinol In cases of elevated uric acid: rasburicase | Oral hydration (1.5-2 L/d), starting 2 d before dose ramp up. | Outpatient, check TLS parameters and creatinine clearance at least 6 to 8 h and 24 h after each ramp up step |
| CT scan | |||||
| Lymphocyte count | |||||
| Blood chemistry | Medium | Any lymph node 5-10 cm OR ALC ≥ 25 × 109/L | Oral hydration or consider IV hydration | Outpatient, check TLS parameters and creatinine clearance at least 6 to 8 h and 24 h after each ramp up step OR inpatient, in case of preexisting abnormalities or relevant coexisting conditions (creatinine clearance <80 mL/min) | |
| Potassium | |||||
| Phosphate | |||||
| Calcium | |||||
| Uric acid | |||||
| Renal function | High | Any lymph node ≥10 cm OR Any lymph node ≥ 5 cm AND ALC ≥ 25 × 109/L | Oral hydration AND intravenous hydration | Admission to an inpatient or day hospital to ensure sufficient IV hydration and TLS monitoring | |
| Creatinine clearance | |||||