Comparing Cairo Bishop and Howard Criteria for Identifying Clinically Meaningful Tumor Lysis Syndrome Among Acute Myeloid Leukemia Patients Treated with Venetoclax and Hypomethylating Agents: A Single Center Experience

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.5095-5095
• Main Authors: Rowe, Margaret, Babushok, Daria V, Carroll, Martin, Carulli, Alison, Frey, Noelle V., Gill, Saar, Hexner, Elizabeth O, Hirsh, Rebecca, Hossain, Nasheed, Lai, Catherine, Loren, Alison W, Luger, Selina M, Maillard, Ivan, McCurdy, Shannon R, Matthews, Andrew H, Martin, Mary Ellen, Paralkar, Vikram R, Perl, Alexander, Porter, David L., Pratz, Keith W, Stadtmauer, Edward A., Jordan Bruno, Ximena
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-186978

Introduction Venetoclax (ven) in combination with hypomethylating agents (HMA) is the standard of care for the treatment of acute myeloid leukemia (AML) in patients (pts) who are ineligible for intensive chemotherapy. The most serious complication of ven is tumor lysis syndrome (TLS). The phase 1b trial of ven and HMA in AML pts included strict prophylactic measures to prevent TLS. Reported rates of TLS in real world cohorts vary widely and prophylactic measures are not standardized. Methods Here we describe TLS prophylaxis (ppx) and incidence in a cohort of 100 consecutive pts age ≥18 years at the University of Pennsylvania who received inpatient or outpatient ven and HMA for up front treatment of AML between 1/2017-8/2022. TLS ppx was at the discretion of the treating team. TLS was retrospectively defined by Cairo Bishop and Howard Criteria (table 1). Howard TLS (H-TLS) criteria differs from Cairo Bishop TLS (CB-TLS) in that it requires two lab abnormalities be present in the same 24-hour period, uses calcium corrected for albumin and does not include ≥25% changes from baseline lab values. Results 92 pts had a white blood cell count (WBC)