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TLS Prophylaxis High Risk — RACP Adult Medicine MCQ

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ModerateHaematologyTLS Prophylaxis High RiskRACP Adult Medicine

A 60-year-old man with high-grade Burkitt lymphoma (bulky disease, LDH 5× ULN, uric acid 0.55 mmol/L at baseline) is about to start chemotherapy. He has normal renal function. What is the most appropriate TLS prophylaxis?

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Correct answer: C — Rasburicase (recombinant urate oxidase)

High-risk TLS (Burkitt lymphoma, bulky disease, high LDH, high WCC, elevated baseline uric acid) warrants rasburicase prophylaxis before commencing chemotherapy, plus aggressive IV hydration (3 L/m²/day). Allopurinol is adequate for intermediate-risk patients. Rasburicase is preferred over allopurinol for high-risk patients because it actively reduces existing uric acid levels.

Reference: ALLG – 2024 – TLS; ASCO/NCCN 2024