TLS: an oncologic
emergency with
potentially devastating
consequences

Tumor lysis syndrome (TLS) is caused by a massive release of intracellular contents into peripheral blood that results in metabolic derangements¹

Hyperuricemia

Hyperkalemia

Hyperphosphatemia

Hypocalcemia

TLS is prevalent in hematologic malignancies with¹:

High proliferative rate
Large cellular burden
High sensitivity to chemotherapy or cytolytic antibody therapy

TLS occurs spontaneously or in response to anticancer therapy, usually 12 to 72 hours after the start of therapy^1,2

TLS associated with hyperuricemia may lead to serious clinical complications²

See full Prescribing Information.

EXPERT REVIEW VIDEO

Watch Dr. Ali McBride explain the relationship between uric acid levels and the risk of TLS in patients with hematologic malignancies.

Are your patients at higher risk for TLS than you think?

Use this Risk Assessment Tool to help you identify patients who may be at risk for TLS

VISIT NOW

Highly effective anticancer therapies can promote rapid cell death leading to TLS^1-3

Rapid cell death can cause the release and catabolism of nucleic acids, resulting in the rise of uric acid levels

Hyperuricemia is one of several metabolic disorders that can lead to TLS, the most common disease-related emergency in hematologic cancers
EXPLORE TLS RISK FACTORS
Both laboratory and clinical symptoms are key to identifying patients with TLS
Cairo-Bishop classification of TLS⁴

LABORATORY TLS

A patient with 2 or more of the following abnormalities within 3 days before to 7 days after initiation of cancer treatment:

Uric acid ≥8 mg/dL or 25% increase from baseline

Potassium ≥6 mEq/dL or 25% increase from baseline

Phosphate ≥6.5 mg/dL (children), ≥4.5 mg/dL (adults), or 25% increase from baseline

Calcium ≥25% decrease from baseline

CLINICAL TLS

A patient with laboratory TLS and at least 1 of the following:

Creatinine ≥1.5x the upper limit of normal (>12 years of age or age adjusted)

Cardiac arrhythmia

Sudden death

Seizure
TLS is the most common disease-related emergency in hematologic cancers³

Incidence of TLS in patients with hematologic malignancies⁵

In a retrospective analysis, a total of 15,051 cases of TLS were identified among the 40,494 patients with hematologic malignancies during this period
This is based on data from the National Inpatient Sample Database, the largest publicly available, all-payer inpatient database⁵
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) recommend that to best manage TLS, anticipate it and initiate treatment prior to anticancer therapy for patients with CLL/SLL, B-cell lymphoma, and ALL^2,6,7

EXPLORE TLS RISK FACTORS

ALL=acute lymphoblastic leukemia; CLL=chronic lymphocytic leukemia; NCCN=National Comprehensive Cancer Network; SLL=small lymphocytic lymphoma.

References: 1. Cortes J, Moore JO, Maziarz RT, et al. Control of plasma uric acid in adults at risk for tumor lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone—results of a multicenter phase III study. J Clin Oncol. 2010;28(27):4207-4213. 2. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for B-Cell Lymphomas. V.4.2022. ©National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed August 26, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 3. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011;364(19):1844-1854. 4. Edeani A, Shirali A. Chapter 4: Tumor Lysis Syndrome. Onco-Nephrology Curriculum. American Society of Nephrology. 2016. https://www.asn-online.org/education/distancelearning/curricula/onco/Chapter4.pdf. Accessed August 26, 2020. 5. Pathak R, Giri S, Aryal M. Recent trends in the incidence and outcomes of tumor lysis syndrome in hematological malignancies: Data from 2010-2014 National Inpatient Sample. Blood. 2017;130:3390. 6. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. V.3.2022 ©National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed August 26, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 7. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Acute Lymphoblastic Leukemia. V.3.2022. © National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed August 26, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

INDICATION

ELITEK is indicated for the initial management of plasma uric acid levels in patients with leukemia, lymphoma, and solid tumor malignancies who are receiving anticancer therapy expected to result in tumor lysis and subsequent elevation of plasma uric acid. ELITEK is indicated only for a single course of treatment.

IMPORTANT SAFETY INFORMATION

WARNING: HYPERSENSITIVITY REACTIONS, HEMOLYSIS, METHEMOGLOBINEMIA, AND INTERFERENCE WITH URIC ACID MEASUREMENTS

Hypersensitivity Reactions: ELITEK can cause serious and fatal hypersensitivity reactions including anaphylaxis. Immediately and permanently discontinue ELITEK in patients who experience a serious hypersensitivity reaction.
Hemolysis: Do not administer ELITEK to patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Immediately and permanently discontinue ELITEK in patients developing hemolysis. Screen patients at higher risk for G6PD deficiency (e.g., patients of African or Mediterranean ancestry) prior to starting ELITEK.
Methemoglobinemia: ELITEK can result in methemoglobinemia in some patients. Immediately and permanently discontinue ELITEK in patients developing methemoglobinemia.
Interference with Uric Acid Measurements: ELITEK enzymatically degrades uric acid in blood samples left at room temperature. Collect blood samples in prechilled tubes containing heparin and immediately immerse and maintain sample in an ice water bath. Assay plasma samples within 4 hours of collection.

CONTRAINDICATIONS

ELITEK is contraindicated in patients with a history of anaphylaxis or severe hypersensitivity to rasburicase or in patients with development of hemolytic reactions or methemoglobinemia with rasburicase. ELITEK is contraindicated in individuals deficient in glucose-6-phosphate dehydrogenase (G6PD).

ADVERSE REACTIONS

Most common adverse reactions (incidence ≥20%), when used concomitantly with anticancer therapy, are vomiting, nausea, fever, peripheral edema, anxiety, headache, abdominal pain, constipation, diarrhea, hypophosphatemia, pharyngolaryngeal pain, and increased alanine aminotransferase.

USE IN SPECIFIC POPULATIONS

Pregnancy: Consider the benefits and risks of ELITEK and possible risks to the fetus when prescribing ELITEK to a pregnant woman
Lactation: Because of the potential for serious adverse reactions in the breastfed child, advise patients that breastfeeding is not recommended during treatment with ELITEK and for 2 weeks after the last dose

Please see full Prescribing Information, including Boxed WARNING.

MAT-US-2020410-v2.0-08/2022

Last Updated: August 2022-08-01

TLS: an oncologic emergency with potentially devastating consequences

Tumor lysis syndrome (TLS) is caused by a massive release of intracellular contents into peripheral blood that results in metabolic derangements1

Hyperuricemia

Hyperkalemia

Hyperphosphatemia

Hypocalcemia

TLS is prevalent in hematologic malignancies with1:

TLS occurs spontaneously or in response to anticancer therapy, usually 12 to 72 hours after the start of therapy1,2

EXPERT REVIEW VIDEO

Are your patients at higher risk for TLS than you think?

VISIT NOW

Highly effective anticancer therapies can promote rapid cell death leading to TLS1-3

Both laboratory and clinical symptoms are key to identifying patients with TLS

TLS is the most common disease-related emergency in hematologic cancers3

Incidence of TLS in patients with hematologic malignancies5