Fixed, low-dose rasburicase for the treatment or prevention of hyperuricemia in adult oncology patients

Herrington, Jon D.; Dinh, Brian

doi:10.1177/1078155214520821

Cited by 27 publications

(50 citation statements)

References 11 publications

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“…[26][27][28] In our cohort, AKI developed in 25% children (n = 30/120) with TLS, of which five children required hemodialysis (4%). The requirement of dialysis in our study is similar to or less than that reported previously, [29][30][31][32] even without the prophylactic use of rasburicase in HRD and despite having a large proportion of patients presenting with AKI. We observed a 1.7% (n = 2) suspected TLS mortality in the study population.…”

Section: Discussionsupporting

confidence: 88%

Risk‐based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource‐limited setting

Gopakumar

Seetharam

Krishna

et al. 2018

Pediatric Blood & Cancer

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Section: Discussionsupporting

confidence: 88%

Risk‐based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource‐limited setting

Gopakumar

Seetharam

Krishna

et al. 2018

Pediatric Blood & Cancer

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“…Campara et al reported that a single low (0.15 mg/kg) dose of rasburicase based on optimal body weight was sufficient to lower urate levels and appeared as effective as the significantly higher doses for multiple days (10). Herrington et al had adjusted their hyperuricemia algorithm to determine the 3-or 6-mg low-dose rasburicase on the baseline UA level (11). Owing to the relatively high cost associated with its use, rasburicase is typically administered at low doses and for <5 days in patients with malignancies attributed to lead exposure to minimize the cost of treatment.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the incidence of tumor lysis syndrome in patients with hematological malignancies treated with rasburicase

Usami

Kimura

Iwai

et al. 2017

Molecular and Clinical Oncology

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Abstract. The purpose of this study was to assess the incidence of tumor lysis syndrome (TLS) in patients with hematological malignancies treated with rasburicase, and to evaluate the dose and duration of rasburicase administration. A total of 52 patients were enrolled. The background of the patients, incidence of TLS and laboratory data were retrospectively examined; in addition, the dose and duration of rasburicase administration and the factors affecting the onset of TLS were evaluated and compared among TLS risk categories. During the study period, 2 (3.8%) of the patients developed clinical TLS and 24 (46.2%) developed laboratory TLS (LTLS). Although the LTLS rate was very high, there were no life-threatening cases of TLS. The median daily dose of rasburicase administered to all patients was 7.5 mg/day (interquartile range, 7.5-9.0 mg/day), and the daily weight-based dose was 0.147 mg/kg/day (range, 0.126-0.178 mg/kg/day). The administration duration was 3 days (interquartile range, 3-4 days). Additionally, there was no significant association between TLS risk classification and daily rasburicase administration dose, duration, or post-administration laboratory data. The factors affecting the onset of TLS included serum uric acid level, as well as serum creatinine and phosphate levels. Rasburicase was highly effective in the prevention and management of hyperuricemia, even at a low-dose (7.5 mg/day) and a duration that was 3 days shorter compared with that recommended by the manufacturer. Therefore, clinicians should administer rasburicase based on their clinical judgment, taking into consideration the cost-effectiveness of this therapy.

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“…The labeled dose is 0.2 mg/kg, daily given as a 30-min IV infusion, for up to 5 days [72]; however, in patients with low-intermediate risk of TLS, the smaller doses (0.1-0.15 mg/kg) were demonstrated to be also efficient, allowing for substantial cost reduction [81]. Alternatively, for patients with the low to moderate risk, a single fixed (3, 4.5, 6, or 7.5 mg) or weightbased (0.15-0.20 mg/kg) dose regimen has been proposed, and its efficacy is demonstrated [82][83][84][85][86][87][88]. A systematic review and meta-analysis of 19 studies by Yu et al [89] revealed that single doses of rasburicase: 6 mg for adults and 1.5 and 0.15 mg/kg for children, were sufficient to normalize and sustain lower uric acid and creatinine levels in adults with TLS.…”

Section: Rasburicasementioning

confidence: 99%

Prevention and Treatment of Tumor Lysis Syndrome in the Era of Onco-Nephrology Progress

Matuszkiewicz‐Rowińska

Małyszko²

2020

Kidney Blood Press Res

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Background: Tumor lysis syndrome (TLS) is an oncologic emergency due to a rapid break down of malignant cells usually induced by cytotoxic therapy, with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and serious clinical consequences such as acute renal injury, cardiac arrhythmia, hypotension, and death. Rapidly expanding knowledge of cancer immune evasion mechanisms and host-tumor interactions has significantly changed our therapeutic strategies in hemato-oncology what resulted in the expanding spectrum of neoplasms with a risk of TLS. Summary: Since clinical TLS is a life-threatening condition, identifying patients with risk factors for TLS development and implementation of adequate preventive measures remains the most critical component of its medical management. In general, these consist of vigilant laboratory and clinical monitoring, vigorous IV hydration, urate-lowering therapy, avoidance of exogenous potassium, use of phosphate binders, and – in high-risk cases – considering cytoreduction before the start of the aggressive agent or a gradual escalation of its dose. Key Messages: In patients with a high risk of TLS, cytotoxic chemotherapy should be given in the facility with ready access to dialysis and a treatment plan discussed with the nephrology team. In the case of hyperkalemia, severe hyperphosphatemia or acidosis, and fluid overload unresponsive to diuretic therapy, the early renal replacement therapy (RRT) should be considered. One must remember that in TLS, the threshold for RRT initiation may be lower than in other clinical situations since the process of cell breakdown is ongoing, and rapid increases in serum electrolytes cannot be predicted.

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Fixed, low-dose rasburicase for the treatment or prevention of hyperuricemia in adult oncology patients

Abstract: Fixed, low dose rasburicase produced a consistent lowering of uric acid levels and may be utilized in the management of hyperuricemia in TLS. Further study is necessary to determine if a larger fixed dose would be required in those patients with a higher baseline uric acid level.

Cited by 27 publications

References 11 publications

Risk‐based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource‐limited setting

Risk‐based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource‐limited setting

Analysis of the incidence of tumor lysis syndrome in patients with hematological malignancies treated with rasburicase

Prevention and Treatment of Tumor Lysis Syndrome in the Era of Onco-Nephrology Progress

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