Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia

Trifilio, Steven; Li, Gordon; Singhal, Seema; Tallman, M. S.; Evens, Andrew M.; Rashid, Khan daker Harun; Fishman, M.; Masino, K.; Pi, J.; Mehta, Jayesh

doi:10.1038/sj.bmt.1705379

Cited by 77 publications

(71 citation statements)

References 13 publications

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“…All patients demonstrated normalization of UA levels within 24 h of administration of rasburicase, without significant rebound of the UA ( Table 1). The patients also demonstrated improvement in serum creatinine and urinary output after treatment (Table 1), which is a finding consistent with those in previous studies [16][17][18][19][20][21][22]. Our study is, to our knowledge, the first reported use of rasburicase in hyperuricemic infants with renal failure.…”

Section: Discussionsupporting

confidence: 93%

Rasburicase improves hyperuricemia in infants with acute kidney injury

et al. 2010

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Recent data suggest that elevated levels of uric acid (UA) might contribute to the progression of renal disease. Rasburicase, recombinant urate oxidase, is a highly safe and efficacious hypo-uricosuric agent for treatment of elevated UA levels from tumor lysis. We adopted the use of rasburicase for management of hyperuricemia in infants with acute kidney injury (AKI) and, herein, report our experience. We conducted a retrospective chart review of infants with hyperuricemia (UA > 8 mg/dl) secondary to AKI (serum creatinine > 1.5 mg/dl) treated with rasburicase. Seven infants (mean age 34 +/- 55 days, six male), with a mean weight of 3.2 +/- 1.2 kg, were identified. Rasburicase was administered intravenously as a single, onetime, bolus of 0.17 +/- 0.04 mg/kg body weight. Within 24 h, serum UA had decreased from 13.6 +/- 4.5 mg/dl to 0.9 +/- 0.6 mg/dl (P < 0.05), creatinine had decreased from 3.2 +/- 2.0 mg/dl to 2.0 +/- 1.2 mg/dl (P < 0.05), and urinary output had increased from 2.4 +/- 1.2 ml/kg per hour to 5.9 +/- 1.8 ml/kg per hour (P < 0.05). Continued improvements in UA, creatinine, and urinary output were observed in the week following administration of rasburicase, without rebound of the UA. We observed no treatment-related side effects. All patients demonstrated a normalization of uric acid level without need of renal replacement therapy. In conclusion, a single intravenously administered bolus of rasburicase appears to be a novel treatment for hyperuricemia in infants with AKI.

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Section: Discussionsupporting

confidence: 93%

Rasburicase improves hyperuricemia in infants with acute kidney injury

et al. 2010

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“…Limited experience suggests that lower doses of rUO are also effective at lowering uric acid levels [6,7]. When 7.5 mg/1V of rUO (0.14 mg/kg) was administered to our patient, his uric acid levels were sufficiently decreased.…”

Section: Chemosensitivementioning

confidence: 86%

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

Watanabe¹,

Tanaka²

2014

CRCM

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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.

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“…[54][55][56][57] Alternative schedules of administration have been recently proposed; however, only a small fraction of the reported patients presented with metabolic abnormalities other than hyperuricemia, so more data are needed to support the possible use of these schedules even in overt TLS. 58,59 Studies comparing rasburicase with allopurinol in the treatment of pediatric patients with hyperuricemia due to TLS have shown better results with rasburicase. In a study by Bosly et al, 56 166 pediatric patients who had leukemia (74%), lymphoma (24%), or solid tumors (3%) were treated with rasburicase.…”

Section: Which Tumor Lysis Syndrome Therapy?mentioning

confidence: 99%

Consensus conference on the management of tumor lysis syndrome

Tosi¹,

Barosi²,

Lazzaro³

et al. 2008

Haematologica

123

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Tumor lysis syndrome is a potentially life threatening complication of massive cellular lysis in cancers. Identification of high-risk patients and early recognition of the syndrome is crucial in the institution of appropriate treatments. Drugs that act on the metabolic pathway of uric acid to allantoin, like allopurinol or rasburicase, are effective for prophylaxis and treatment of tumor lysis syndrome. Sound recommendations should regulate diagnosis and drug application in the clinical setting. The current article reports the recommendations on the management of tumor lysis syndrome that were issued during a Consensus Conference project, and which were endorsed by the Italian Society of Hematology (SIE), the Italian Association of Pediatric Oncologists (AIEOP) and the Italian Society of Medical Oncology (AIOM). Current concepts on the pathophysiology, clinical features, and therapy of tumor lysis syndrome were evaluated by a Panel of 8 experts. A consensus was then developed for statements regarding key questions on tumor lysis syndrome management selected according to the criterion of relevance by group discussion. Hydration and rasburicase should be administered to adult cancer patients who are candidates for tumor-specific therapy and who carry a high risk of tumor lysis syndrome. Cancer patients with a low-risk of tumor lysis syndrome should instead receive hydration along with oral allopurinol. Hydration and rasburicase should also be administered to patients with clinical tumor lysis syndrome and to adults and high-risk children who develop laboratory tumor lysis syndrome. In conclusion, the Panel recommended rasburicase for tumor lysis syndrome prophylaxis in selected patients based on the drug efficacy profile. Methodologically rigorous studies are needed to clarify its cost-effectiveness profile.

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Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia

Cited by 77 publications

References 13 publications

Rasburicase improves hyperuricemia in infants with acute kidney injury

Rasburicase improves hyperuricemia in infants with acute kidney injury

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

Consensus conference on the management of tumor lysis syndrome

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