Question

In a patient with Burkitt lymphoma undergoing chemotherapy, grading of tumor lysis syndrome is based on which classification system that defines both laboratory and clinical TLS?

• A. Cairo–Bishop score
• B. Ann Arbor staging
• C. Deauville scoring
• D. Lugano classification

Hint:

The metabolic triad of Tumor Lysis Syndrome includes Hyperkalemia, Hyperphosphatemia, and Hyperuricemia.
Hypocalcemia also occurs, but it is a secondary consequence of the hyperphosphatemia (calcium and phosphate precipitate together in tissues).

Answer 1

The Correct Option is A

Concept:
Tumor Lysis Syndrome (TLS) is a potentially life-threatening oncologic emergency characterized by massive cytolysis and the sudden release of intracellular contents into the systemic circulation, leading to severe metabolic derangements.
It most commonly occurs following the initiation of cytotoxic chemotherapy in rapidly proliferating hematologic malignancies, such as Burkitt lymphoma or acute leukemias.
The question asks for the specific classification system used to define and grade TLS.
Explanation:
• The universally accepted standard for defining and classifying Tumor Lysis Syndrome is the Cairo-Bishop classification system.

• The Cairo-Bishop criteria separate TLS into two distinct categories: Laboratory TLS (LTLS) and Clinical TLS (CTLS).

• Laboratory TLS is defined by the presence of $\geq$ 2 metabolic abnormalities (hyperuricemia, hyperkalemia, hyperphosphatemia, or hypocalcemia) occurring within 3 days before or 7 days after the initiation of therapy.

• Clinical TLS is defined when Laboratory TLS is accompanied by one or more significant clinical complications directly related to the metabolic derangements, such as acute kidney injury (AKI), cardiac arrhythmias, or seizures.

• Option (B), Ann Arbor staging, is utilized to determine the anatomical stage and extent of lymphomas (Hodgkin and Non-Hodgkin).

• Option (C), Deauville scoring, is a 5-point scale used to interpret FDG-PET scans for assessing treatment response in lymphomas.

• Option (D), Lugano classification, is a modern modification of the Ann Arbor system used for staging and evaluating the response to therapy in lymphomas.
Final answer:
The Cairo-Bishop score is the established system for defining both laboratory and clinical Tumor Lysis Syndrome.