What is the Cairo-Bishop framework?

Cairo and Bishop defined laboratory and clinical TLS and a risk model in which the malignancy type, tumour burden (reflected by white cell count and LDH), and the patient's baseline renal function and uric acid determine the likelihood of developing TLS once cytotoxic therapy is started.

Which tumours are highest risk?

Bulky, rapidly dividing, treatment-sensitive tumours top the list — Burkitt lymphoma and lymphoblastic lymphoma, acute lymphoblastic leukaemia with a high white cell count, and acute myeloid leukaemia with a very high count. Most solid tumours are low risk unless very bulky and chemo-sensitive.

How does the LDH and white cell count change risk?

A high lactate dehydrogenase and a high white cell count both signal a large, proliferative tumour mass that will release large amounts of potassium, phosphate, and nucleic acids when it lyses. The tool escalates the tier when these markers are high, in line with published thresholds such as a white cell count above 100.

What prophylaxis does each tier need?

Low risk usually needs vigilant monitoring and oral hydration. Intermediate risk needs intravenous hydration plus allopurinol. High risk needs aggressive intravenous hydration plus rasburicase, with close monitoring of potassium, phosphate, calcium, urate, and renal function.

Is rasburicase always safe?

No. Rasburicase is contraindicated in glucose-6-phosphate dehydrogenase (G6PD) deficiency because it can cause severe haemolysis and methaemoglobinaemia. Screen for G6PD deficiency before use, and follow local protocols; this tool flags rasburicase as an option, not an order.

Tumour Lysis Syndrome Risk Calculator (Cairo-Bishop)

Tumour lysis syndrome can be life-threatening but is largely preventable when high-risk patients are identified before chemotherapy. This tool applies a Cairo-Bishop-based risk stratification from the tumour type, white cell count, LDH, and baseline patient factors, and suggests the matching prophylaxis tier.

How it works

The tool scores three groups of factors and assigns the highest applicable tier:

Tumour type:
  high-risk lymphoma/leukaemia (Burkitt, lymphoblastic, ALL/AML) -> high
  intermediate lymphomas / other leukaemias                      -> intermediate
  most solid tumours                                             -> low

Tumour burden escalators (move risk up a tier):
  WBC > 100 ×10^9/L, or markedly raised LDH (≥ 2× upper limit)

Patient escalators (move risk up a tier):
  baseline renal impairment, pre-existing high urate/electrolytes,
  or volume depletion

Prophylaxis:
  low          -> monitor + oral hydration
  intermediate -> IV hydration + allopurinol
  high         -> IV hydration + rasburicase (screen G6PD first)

The final tier is the most severe one triggered by any factor, because a single high-risk feature is enough to warrant escalated prophylaxis.

Example and notes

A patient with acute lymphoblastic leukaemia and a white cell count of 150 ×10⁹/L is high risk on tumour type alone, reinforced by the high count, and needs intravenous hydration plus rasburicase after G6PD screening. A patient with a small, indolent solid tumour and normal labs is low risk and needs monitoring and oral hydration. Always recheck potassium, phosphate, calcium, urate, and renal function around treatment, and follow local protocols — this tool guides the tier, it does not prescribe.