TLS Prophylaxis Intermediate Risk — RACP Adult Medicine MCQ

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EasyHaematologyTLS Prophylaxis Intermediate RiskRACP Adult Medicine

A 45-year-old woman at intermediate risk of TLS (DLBCL, moderate tumour burden, normal baseline labs) is starting R-CHOP chemotherapy. What is the most appropriate TLS prophylaxis?

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Correct answer: A — Allopurinol 300 mg daily

Intermediate-risk TLS (DLBCL, moderate burden, normal baseline labs) is managed with allopurinol prophylaxis (300 mg daily, commenced 1-2 days before chemotherapy and continued for 7-10 days) plus IV hydration (2-3 L/day). Allopurinol inhibits xanthine oxidase, preventing new uric acid formation. Monitor electrolytes, uric acid, and creatinine every 6-12 hours during initial chemotherapy.

Reference: ALLG – 2024 – TLS; ASCO 2024