Renal Complications in Oncologic Patients

Givens, Melissa L.; Crandall, Joy

doi:10.1016/j.hoc.2010.03.001

Cited by 11 publications

(15 citation statements)

References 30 publications

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“…20 Renal failure occurred in 98% of patients with clinical TLS, and dialysis was necessary in 18% of patients. 20 The prevention and treatment of TLS are becoming more important with increasing use of potentially nephrotoxic chemotherapy agents, such as ifosfamide or methotrexate, 21 that may increase the risk of TLS. Some immunomodulating agents, including rituximab and lenalidomide, have been reported to cause hyperuricemia and TLS in patients with chronic lymphocytic leukemia and other lymphoproliferative disorders.…”

Section: Discussionmentioning

confidence: 99%

Control of Plasma Uric Acid in Adults at Risk for Tumor Lysis Syndrome: Efficacy and Safety of Rasburicase Alone and Rasburicase Followed by Allopurinol Compared With Allopurinol Alone—Results of a Multicenter Phase III Study

Cortes

Moore²,

Maziarz³

et al. 2010

JCO

173

149

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Purpose Rasburicase is effective in controlling plasma uric acid in pediatric patients with hematologic malignancies. This study in adults evaluated safety of and compared efficacy of rasburicase alone with rasburicase followed by oral allopurinol and with allopurinol alone in controlling plasma uric acid. Patients and Methods Adults with hematologic malignancies at risk for hyperuricemia and tumor lysis syndrome (TLS) were randomly assigned to rasburicase (0.20 mg/kg/d intravenously days 1-5), rasburicase plus allopurinol (rasburicase 0.20 mg/kg/d days 1 to 3 followed by oral allopurinol 300 mg/d days 3 to 5), or allopurinol (300 mg/d orally days 1 to 5). Primary efficacy variable was plasma uric acid response rate defined as percentage of patients achieving or maintaining plasma uric acid ≤ 7.5 mg/dL during days 3 to 7. Results Ninety-two patients received rasburicase, 92 rasburicase plus allopurinol, and 91 allopurinol. Plasma uric acid response rate was 87% with rasburicase, 78% with rasburicase plus allopurinol, and 66% with allopurinol. It was significantly greater for rasburicase than for allopurinol (P = .001) in the overall study population, in patients at high risk for TLS (89% v 68%; P = .012), and in those with baseline hyperuricemia (90% v 53%; P = .015). Time to plasma uric acid control in hyperuricemic patients was 4 hours for rasburicase, 4 hours for rasburicase plus allopurinol, and 27 hours for allopurinol. Conclusion In adults with hyperuricemia or at high risk for TLS, rasburicase provided control of plasma uric acid more rapidly than allopurinol. Rasburicase was well tolerated as a single agent and in sequential combination with allopurinol.

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Section: Discussionmentioning

confidence: 99%

Control of Plasma Uric Acid in Adults at Risk for Tumor Lysis Syndrome: Efficacy and Safety of Rasburicase Alone and Rasburicase Followed by Allopurinol Compared With Allopurinol Alone—Results of a Multicenter Phase III Study

Cortes

Moore²,

Maziarz³

et al. 2010

JCO

173

149

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“…The interesting finding regarding the risk factors for TLS of this study was that the pre‐chemotherapy hypophosphatemia was a significant independent risk factor, which is a novel finding as far as we know. In TLS, high phosphorus level is one of the criteria defining this syndrome that results from a massive lysis of tumour cells, because phosphorus is one of the major cellular components . On the other hand, for the tumour cells to proliferate and then be lysed on chemotherapy, phosphorus is required and consumed in the synthesis of cellular components, causing extracellular phosphorus to need to be shifted into the cancer cells , which might result in hypophosphatemia in some cases.…”

Section: Discussionmentioning

confidence: 99%

Tumour lysis syndrome in children: experience of last decade

Ahn

Kang²,

Shin³

et al. 2011

Hematological Oncology

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The strategy against tumour lysis syndrome (TLS) had been hyperhydration, urine alkalinization, and allopurinol. Recently, rasburicase was added to the armament against this life-threatening condition. In Korea, rasburicase is used as a rescue therapy for cases with allopurinol-resistant hyperuricemia, because of the restriction by the National Health Insurance. We reviewed our experiences to re-assess the risk factors of TLS and the efficacy of rasburicase. Medical records were retrospectively reviewed for 396 children who were diagnosed as positive with acute leukemia and non-Hodgkin lymphoma between the years 2000 and 2009. The risk factors for TLS were analyzed statistically, and those before and after the availability of rasburicase were compared. Sixty eight patients (17.2%) had TLS. Multivariate analysis showed that pre-chemotherapy hypophosphatemia was a risk factor for TLS, in addition to the known risk factors of hyperuricemia and high lactate dehydrogenase concentration. The availability of rasburicase as a rescue therapy did not negate the importance of uric acid as a risk factor of TLS. Rasburicase as a second line treatment for intractable hyperuricemia was not effective in reducing the incidence of TLS. Pre-chemotherapy hypophosphatemia was a significant independent risk factor for TLS.

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“…9,10 We also found that the use of diuretics and other medications affecting electrolyte levels were not significantly different between groups, therefore it is quite likely the difference in magnesium repletion in our study was due to the difference in the acid-suppressive agent used.…”

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confidence: 57%