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Background: TLS is considered an oncologic emergency and occurs hen large numbers of malignant cells die and release massive amounts of certain intracellular contents especially potassium and phosphorus . Guidelines for the prevention and management of TLS typically involve some combination of hydration, alkalinization, and hypouricemic agents. There is hoever a lack of published data addressing the best management for patients ith ALL ho are at very lo risk of developing TLS. Methods: We revieed the records of all patients diagnosed ith ALL at our institution over the past five years to identify those managed ithout either allopurinol or Rasburicase. Data ere collected that ere required to establish either laboratory or clinical TLS serum levels of potassium, phosphorus, uric acid, calcium, creatinine, and evidence of cardiac arrhythmia, seizure, or death per the 2010 Cairo-Bishop definition [Br J Haematol, 149 2010 ]. We revieed lab values from three days prior to seven days folloing the start of systemic therapy. Results: One hundred eighty children have been diagnosed ith ALL, ten of hom met our inclusion criteria. Five ere hyperhydrated and alkalinized hile the other five received hyperhydration alone. None of them received allopurinol or Rasburicase. All ten ere diagnosed ith B-Lymphoblastic Leukemia. All but one ere considered standard risk; the tenth as assigned high risk because of age. None of the ten patients developed either lab or clinical TLS. In fact only to of the 371 labs for the key components of the TLS potassium, phosphorus, uric acid, creatinine ere even abnormal, given the patients age. Conclusions: These results support the hypothesis that there is a population of children ith ALL for hom hyperhydration alone is sufficient and appropriate treatment for the prevention of TLS. When e project characteristics common to our ten patients WBC lt 50, age beteen 1 and 18, ithout hyperuricemia at presentation onto our most recently diagnosed leukemic patient population, e estimate that over 50 percent of them 30 of 56 may have successfully been managed in this ay. We recommend a prospective trial to confirm our hypothesis.,J Clin Oncol 34, 2016 suppl; abstr e22012 ,Publication Only Pediatric Oncology
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