Efficacy and safety of rasburicase, a recombinant urate oxidase (Elitek™), in the management of malignancy-associated hyperuricemia in pediatric and adult patients: final results of a multicenter compassionate use trial

Jeha, Sima; Kantarjian, H.; Irwin, David; Shen, Violet; Shenoy, Surendra; Blaney, Susan M.; Camitta, Bruce M.; Pui, Ching‐Hon

doi:10.1038/sj.leu.2403566

Cited by 162 publications

(126 citation statements)

References 19 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…Historically, in studies that did not involve rUO 10% -20% of patients with hematological malignancies required hemodialysis, but a more recent study found that the use of rUO decreased the frequency of hemodialysis to just a few percent [5].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful prevention of tumor lysis syndrome using recombinant urate oxidase in patient with metastasic and bulky prostate rhabdomyosarcoma

Watanabe¹,

Tanaka²

2014

CRCM

View full text Add to dashboard Cite

Tumor lysis syndrome (TLS) is a life-threatening oncological emergency that frequently occurs in patients with hematological malignancies. It is becoming more common in patients with solid tumors because of advances in molecular targeted therapies. Recombinant urate oxidase (rUO) is effective at preventing and treating hyperuricemia, but clinicians who treat adult patients with solid tumors are generally not aware of this. In addition, the treatment guidelines for TLS do not include indications for rUO treatment for chemosensitive sarcoma. We report an adolescent case of metastatic rhabdomyosarcoma (RMS), in which clinical TLS was successfully prevented using rUO. A 16-year-old Japanese male suffered from urinary retention and bone pain and was diagnosed with prostate RMS combined with multiple bone metastases and bone marrow involvement. He was judged to be at high risk of clinical TLS because his prostate tumor was bulky and he displayed laboratory TLS. rUO was administered during chemotherapy. Soon after the initiation of chemotherapy, his disseminated intravascular coagulation (DIC) got worse, and his lactate dehydrogenase (LDH) level was elevated due to tumor lysis. However, his serum uric acid levels remained low, and he was prevented from falling into acute renal failure. The planned regimen was successfully completed without life-threatening complications, and the patient achieved a complete response after 2 courses of chemotherapy. The international TLS consensus panel developed recommendations for TLS prophylaxis, but did not define the TLS risk classification of RMS. We recommend that RMS should be treated like neuroblastoma because it grows rapidly and is highly chemosensitive. Our patient was considered to be indicated for rUO because he displayed urinary retention, DIC, and laboratory TLS before chemotherapy. These features might be useful as indications for rUO therapy, which can safely support chemotherapy.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Although the major cause of ARF is uric acid nephropathy secondary to tumor lysis, hyperphosphatemia also induces severe ARF, which can lead to a requirement for hemodialysis [5]. Hyperkalemia, which can result in severe arrhythmia and sudden death, is another potentially a life-threatening consequence of TLS.…”

Section: Chemosensitivementioning

confidence: 99%

Successful prevention of tumor lysis syndrome using recombinant urate oxidase in patient with metastasic and bulky prostate rhabdomyosarcoma

Watanabe¹,

Tanaka²

2014

CRCM

View full text Add to dashboard Cite

show abstract

“…The strategy in preventing and treating infectious complications applied the same principles as used in BFM group. 23 Rasburicase, 24 a recombinant urate oxidase, has been available for effective prevention and treatment of leukemia lysis syndrome for the recent 2 years.…”

Section: Supportive Carementioning

confidence: 99%

Improved treatment results for childhood acute myeloid leukemia in Taiwan

et al. 2005

View full text Add to dashboard Cite

To improve treatment results for children with de novo acute myeloid leukemia (AML), we introduced a novel protocol, Taiwan Pediatric Oncology Group-AML-97A, for AML other than acute promyelocytic leukemia (APL), for which modified conventional protocols were used. From January 1, 1997, to December 31, 2002, 141 children younger than 17 years old with de novo AML were enrolled. In total, 117 patients with non-APL AML were treated with induction therapy of idarubicin and cytarabine (Ara-C), postremission therapy with high-dose Ara-C -containing regimens for four monthly courses, and moderatedose therapy with idarubicin and Ara-C for four monthly courses. The first 19 patients with APL were treated with alltrans retinoic acid, idarubicin and Ara-C, with the remaining five patients receiving all-trans retinoic acid and idarubicin, followed by maintenance therapy for 2 years. Stem cell transplantation was performed in 29 patients in first remission with a similar outcome as chemotherapy alone. The remission rate in the AML-97A study was 90%, the 5-year survival 5175.3% (s.e.) and the 5-year event-free survival 5074.8%; for APL, these were 100%, 8677.0, and 7579.8%. For the whole group, the 5-year survival was 5774.7% and the 5-year event-free survival 5474.4%. The AML-97A regimen was well tolerated.

show abstract

“…Studies that did not use rUO reported that 10% -20% of patients with hematological malignancies required hemodialysis; however, a more recent study found that the use of rUO decreased the frequency of hemodialysis to just a few percent [7]. Although rUO only affects uric acid levels, progression to hyperphosphatemia, hyperkalemia and DIC should be considered.…”

Section: Discussionmentioning

confidence: 99%

Severe Hyperphosphatemia Resulting in Acute Renal Failure and Ischemic Encephalopathy in a Patient with Infantile Leukemia

Watanabe¹,

Itano²,

Koga³

et al. 2014

CRCM

View full text Add to dashboard Cite

Tumor lysis syndrome (TLS), hyperleukocytosis, and disseminated intravascular coagulation (DIC) are representative oncological emergencies that overlap mutually at the beginning of therapy for aggressive leukemia. Lately recombinant urate oxidase (rUO) enables to control uric acid level and its crystallization, the most frequent risk factor for clinical TLS; therefore, hyperphosphatemia appears to be the main risk in the rUO era. We here report an infantile leukemia patient who developed severe hyperphosphatemia, resulting in acute renal failure and ischemic encephalopathy. A 9-month-old female baby was adynamic with a bulging anterior fontanel, and was diagnosed as infantile acute lymphoblastic leukemia with a mixed lineage leukemia gene rearrangement. A laboratory examination revealed leukocytosis, bicytopenia, hyperuricemia, a prolonged prothrombin time, activated partial thromboplastin time, and elevated lactate dehydrogenase level. Soon after a reduced dose of prednisolone was administered, she developed hypoxia caused by systemic inflammatory response syndrome and heart failure. Her white blood cell count decreased sharply, leading to acute renal failure due to hyperphosphatemia, which required continuous hemodiafiltration for 48 hours. Although renal function subsequently recovered, severe ischemic encephalopathy remained. She achieved morphological remission once, however, relapsed and passed away soon after. We have to pay attention to the progression of hyperphosphatemia, hyperkakemia and DIC, although hyperuricemia was controlled using rUO. Changes in electrolyte * Corresponding author. A. Watanabe et al. 130levels must be continuously monitored, and TLS, DIC and/or hyperleukocytosis should be promptly managed especially in patients who are sensitive to therapy.

show abstract

Efficacy and safety of rasburicase, a recombinant urate oxidase (Elitek™), in the management of malignancy-associated hyperuricemia in pediatric and adult patients: final results of a multicenter compassionate use trial

Cited by 162 publications

References 19 publications

Successful prevention of tumor lysis syndrome using recombinant urate oxidase in patient with metastasic and bulky prostate rhabdomyosarcoma

Successful prevention of tumor lysis syndrome using recombinant urate oxidase in patient with metastasic and bulky prostate rhabdomyosarcoma

Improved treatment results for childhood acute myeloid leukemia in Taiwan

Severe Hyperphosphatemia Resulting in Acute Renal Failure and Ischemic Encephalopathy in a Patient with Infantile Leukemia

Contact Info

Product

Resources

About