Grand Rounds

Advanced Practice Perspectives on Preventing and Managing Tumor Lysis Syndrome and Neutropenia in Chronic Lymphocytic Leukemia

Amy Goodrich, RN, MSN, CRNP

From Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland

Author’s disclosure of conflict of interest is found at the end of this article.

Correspondence to: Amy Goodrich, RN, MSN, CRNP, Johns Hopkins School of Medicine, Kimmel Cancer Center, 550 North Broadway, Baltimore, MD 21205. E-mail: goodram@jhmi.edu


J Adv Pract Oncol 2021;12(1):56–70 | https://doi.org/10.6004/jadpro.2021.12.1.5 | © 2021 Harborside™


  

ABSTRACT

Tumor lysis syndrome (TLS) and neutropenia are significant toxicities in the treatment of chronic lymphocytic leukemia (CLL). Both TLS and neutropenia can lead to potentially life-threatening complications for patients with chronic lymphocytic leukemia undergoing antineoplastic therapy. This article focuses on diligent risk assessment, prophylaxis, early identification, monitoring, patient education, and prompt intervention for TLS and neutropenia. These are all necessary steps to reduce life-threatening complications. Guidelines are available for risk assessments for both TLS and neutropenia. Once risk is established, prophylaxis and monitoring recommendations can be found in available guidelines. There are no established guidelines or widely used decision-making standards for the treatment of clinical TLS. General management strategies are well documented in the literature, with some degree of customization to each individual patient. If fever occurs in the setting of neutropenia, there are well-established guidelines for management, including guidance on anti-infective agents and use of growth factors. In addition, awareness and proper actions regarding TLS and neutropenia are key to preventing treatment delays, dose reductions, or treatment discontinuation. Adequate planning for TLS and neutropenia is critical to optimize patient outcomes. 




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