肿瘤溶解综合征（TLS）可以自发发生也可以由于抗癌治疗而触发，导致细胞内的钾、磷和核酸释放至血液中，进而引起可能致命的继发临床并发症。先前的TLS指南未考虑到潜在的新型抗肿瘤药物或目前治疗范式中TLS风险增加的现象。因此，我们召集了一组修订DAO研究小组，根据支持性文献和实践共识，提供TLS管理指南的更新。 我们实施了三轮修订DAO流程。第一轮，九位专家成员完成了一个基于已发表文献的网络问卷。第二轮，专家被要求重新考虑那些未达成共识的问题（定义为投票专家中≥ 66％的同意）。第三轮是一个非盲［受协调的虚拟会议，讨论任何未达成共识的问题。 我们就TLS风险和并发症的预防、监测和管理提供了详细的建议，其中水合是TLS预防和管理的关键要素。在急性TLS的治疗和预防慢性肾脏损害方面，我们提出了针对高钾血症、低钙血症、高磷血症和高尿酸血症的管理指南。 尽管目前可用的药物对尿酸水平的控制非常有效，但专家强调监测和治疗其他危险的电解质异常，如高钾血症和高磷血症的重要性。这个修订DAO小组的指南应该有助于临床医生预防和管理TLS。 版权所有 © 2023. 由Elsevier Ltd.出版。

Tumor lysis syndrome (TLS), which occurs spontaneously or in response to anticancer treatment, results in the release of intracellular potassium, phosphorus, and nucleic acids into the bloodstream, which results in secondary clinical complications that may be fatal. Prior TLS guidelines do not take into consideration potent novel oncologic agents or contemporary treatment paradigms with increased risk of TLS. Thus, a modified Delphi panel of experts was convened to provide an update for TLS management guidelines based upon a combination of supporting literature and practice consensus.A three-round modified Delphi process was implemented. For round 1, nine expert panelists completed a web-based questionnaire developed using published literature. In round 2, panelists were asked to reconsider their answers to questions that did not reach consensus (defined as ≥ 66% agreement among voting panelists). Round 3 was an unblinded, moderated virtual meeting to discuss any remaining questions that did not reach consensus.Detailed recommendations are given for prophylaxis, monitoring, and management of TLS risks and complications, with hydration being a key element of TLS prophylaxis and management. Guidelines for the management of acute effects of TLS and prevention of long-term renal effects include management of hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia.Although the control of uric acid levels is quite effective with currently available agents, panelists emphasize the importance of monitoring and treating other dangerous electrolyte abnormalities such as hyperkalemia and hyperphosphatemia. Guidelines from this modified Delphi panel should aid clinicians in preventing and managing TLS.Copyright © 2023. Published by Elsevier Ltd.