1. Tumour lysis syndrome can be prevented by adequate hydration, maintaining a good diuresis and administering allopurinol. Once established, haemo(dia)filtration and other measures to lower serum potassium levels may be necessary.

2. The raised white cell mass may be reduced by leucophoresis.

3. Frequent blood transfusions to maintain Hb levels >7 g/dl

4. Platelet transfusions are required if counts remain <10-20 x 109/l, or if <50 x 109/l and remaining symptomatic or undergoing an invasive procedure.

5. Give fresh frozen plasma and other blood products as needed.

6. Neutropenia management, including protective isolation, appropriate antibiotic therapy, ± granulocyte colony stimulating factor.

7. GVHD is managed by supportive treatment and parenteral nutrition. Prostaglandin E1 and immunosuppression may be helpful.

8. Psychological support for both patient and family is vital.

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