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©2013 UpToDate ® Print Email Cairo-Bishop clinical tumor lysis syndrome definition* and grading Complication Grade 0 1 2 3 4 5 Creatinine•Δ ≤1.5 x ULN 1.5 x ULN >1.5-3.0 x ULN >3.0-6.0 x ULN >6.0 x ULN Death Cardiac arrhythmia• None Intervention not indicated Nonurgent medical intervention indicated Symptomatic and incompletely controlled medically or controlled with device (eg, defibrillator) Life-threatening (eg, arrhythmia associated with HF, hypotension, syncope, shock) Death Seizure• None - One brief, generalized seizure; seizure(s) well controlled by anticonvulsants or infrequent focal motor seizures not interfering with ADL Seizure in which consciousness is altered; poorly controlled seizure disorder; with breakthrough generalized seizures despite medical intervention Seizure of any kind which are prolonged, repetitive or difficult to control (eg, status epilepticus, intractable epilepsy) Death ULN: upper limit of normal; HF: heart failure; ADL: activities of daily living. * Clinical tumor lysis syndrome defined as laboratory tumor lysis syndrome plus at least one clinical complication • Not directly or probably attributable to therapeutic agent. Δ If no institutional ULN is specified, age/sex ULN creatinine may be defined as follows: >1 to <12 years of age, both male and female, 61.6 mmol/L; ≥12 to <16 years, both male and female, 88 mmol/L; ≥16 years, female 105.6 mmol/L, male 114.4 mmol/L. Reproduced with permission from: Coiffier B, Altman A, Pui CH, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26:2767. Copyright © 2008 American Society of Clinical Oncology. All rights reserved.