Modified Cairo-Bishop Criteria

Criteria for laboratory and clinical tumor lysis syndrome (TLS)

2004 Cairo-Bishop criteria for TLS,1 incorporating modifications proposed by Howard et al in 2011.2

Laboratory tumor lysis syndrome

Two or more of the following criteria occurring within 24 hours, and within three days before or seven days after therapy:

  • Potassium ≥ 6.0 mmol/L
  • Phosphorus ≥ 1.45 mmol/L (≥ 4.5 mg/dL) in adults*
  • Corrected calcium ≤ 1.75 mmol/L (≤ 7.0 mg/dL), OR ionized calcium ≤ 0.3 mmol/L (≤ 1.12 mg/dL)
  • Urate ≥ 476 μmol/L (≥ 8.0 mg/dL) in adults**

* phosphorus ≥ 2.1 mmol/L (≥ 6.5 mg/dL) in children
** urate above age-specific reference range in children

Note: Original 2004 Cairo-Bishop criteria also define a ≥ 25% change from baseline as meeting each of these criteria, and do not require the criteria to occur within the same 24 hour period.1

Clinical tumor lysis syndrome

One or more of the following, in a patient meeting criteria for laboratory TLS:

  • Creatinine increase of ≥ 26.5 μmol/L (≥ 0.3 mg/dL)***
  • Oliguria (< 0.5 mL/kg/h for 6 hours)
  • Symptomatic hypocalcemia****
  • Cardiac dysrhythmia
  • Seizure
  • Sudden death

*** or creatinine ≥ 1.5x age-specific upper limit of reference range if no baseline measurement available
**** includes tetany, muscle spasms, parasthesiae, bronchospasm, laryngospasm, hypotension

Note: Original 2004 Cairo-Bishop criteria do not specify oliguria or symptomatic hypocalcemia within the definition of clinical TLS.1

Cairo-Bishop criteria for laboratory and clinical TLS were published in 2004,1 and themselves are modifications of the 1993 Hande-Garrow classification.3

Modifications to the 2004 Cairo-Bishop criteria, requiring two or more laboratory criteria within 24 hours, and removing the definition of a 25% change in biochemical parameters for the definition of laboratory TLS, were proposed in 2011.2

TLS: tumor lysis syndrome