SFCE (Société Française de Lutte contre les Cancers et Leucémies de l'Enfant et de l'Adolescent) Recommendations for the Management of Tumor Lysis Syndrome (TLS) With Rasburicase: An Observational Survey

Bertrand, Yves; Méchinaud, Françoise; Brethon, Benoît; Mialou, Valérie; Auvrignon, Anne; Nelken, Brigitte; Notz-Carrère, Anne; Plantaz, Dominique; Patte, Catherine; Urbieta, M.; Baruchel, André; Leverger, G

doi:10.1097/mph.0b013e318162bd41

Cited by 18 publications

(14 citation statements)

References 20 publications

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“…Urate oxidase is administered with varying doses and durations, depending on the level of risk. The major advantages of urate oxidase are rapid fall in serum uric acid level after a single dose and no prerequisite for urinary alkalinization; however, high acquisition cost and hemolysis in patients with G6PD enzyme deficiency are the major drawbacks limiting its use [2,7,12,23]. In the present study serum uric acid levels returned to normal in a mean 3.5 d. We think that selective use of allopurinol is a rational approach in such cases when resources are limited.…”

Section: Discussionmentioning

confidence: 50%

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Hyperuricemia and tumor lysis syndrome in children with non-Hodgkin’s lymphoma and acute lymphoblastic leukemia

Sevinir¹,

Demirkaya²,

Baytan³

et al. 2011

Turk J Hematol

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Objective: This study aimed to examine the incidence, clinical characteristics, and outcome of hyperuricemia and tumor lysis syndrome (TLS) in children with non-Hodgkin's lymphoma (NHL) and acute lymphoblastic leukemia (ALL). Materials and Methods: This retrospective study included data from 327 patients (113 NHL and 214 ALL). Results: Hyperuricemia occurred in 26.5% and 12.6% of the patients with NHL and ALL, respectively. The corresponding figures for TLS were 15.9% and 0.47% (p=0.001). All hyperuricemic NHL patients had advanced disease and renal involvement was present in 53%. All hyperuricemic ALL patients had a leukocyte count >50,000 mm 3 at the time of diagnosis. Among the hyperuricemic NHL and ALL patients, 96.6% and 66.6% had LDH ≥500 UI/L, respectively. Treatment consisted of hydration and allopurinol; none of the patients received urate oxidase. Among the patients that developed TLS, 26.3% had laboratory TLS, 42.1% had grade I or II TLS, and 31.6% had grade III or IV TLS. Uric acid levels returned to normal after a mean period of 3.5±2.5 and 3.05±0.8 d in NHL and ALL groups, respectively. In all, 7% of the patients with hyperuricemia required hemodialysis. None of the patients died. Conclusion: In this series the factors associated with a high-risk for TLS were renal involvement in NHL and high leucocyte count in ALL. Management with allopurinol and hydration was effective in this group of patients with high tumor burden. (Turk J Hematol 2011; 28: 52-9) Key words: Non-Hodgkin's lymphoma, leukemia, tumor lysis syndrome, hyperuricemia, children Received: January 28, 2010 Accepted: April 30, 2010 Özet Amaç: Çalışmanın amacı NHL ve ALL'li çocuklarda hiperürisemi ve TLS sıklığını, klinik özellikleri ve sonuçlarını tanımlamaktır.

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Section: Discussionmentioning

confidence: 50%

“…Substitution of allopurinol with urate oxidase has been reported to decrease the incidence and severity of TLS [22,23]. The cost-effectiveness of urate oxidase is a subject of continuing research worldwide [24].…”

Section: Discussionmentioning

confidence: 99%

Hyperuricemia and tumor lysis syndrome in children with non-Hodgkin’s lymphoma and acute lymphoblastic leukemia

Sevinir¹,

Demirkaya²,

Baytan³

et al. 2011

Turk J Hematol

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“…An observational study has shown that treatment with rasburicase according to this new guideline is effective in preventing and controlling hyperuricemia and TLS in children with hematologic malignancies [23]. The study reported that the duration of rasburicase treatment should be tailored to the duration and intensity of tumor cell lysis in the patient by closely monitoring clinical chemistry.…”

Section: Discussionmentioning

confidence: 98%

A study of rasburicase for the management of hyperuricemia in pediatric patients with newly diagnosed hematologic malignancies at high risk for tumor lysis syndrome

et al. 2009

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Tumor lysis syndrome (TLS), including hyperuricemia, is a frequent serious complication in patients with hematologic malignancies. This study in Japanese patients evaluated the efficacy, safety, and pharmacokinetic profile of rasburicase in pediatric patients with hematologic malignancies. Patients aged <18 years at high risk for TLS, with newly diagnosed hematologic malignancies, were randomized to intravenous rasburicase 0.15 mg/kg/day (n = 15) or 0.20 mg/kg/day (n = 15) for 5 days. Chemotherapy was started 4-24 h after the first rasburicase dose. Response was defined as a reduction in plasma uric acid to < or = 6.5 mg/dL (patients <13 years) or < or = 7.5 mg/dL (patients > or = 13 years) by 48 h after the first administration, lasting until 24 h after the final administration. Response rates were 93.3 and 100% with rasburicase 0.15 and 0.20 mg/kg/day, respectively. Uric acid levels declined rapidly within 4 h of starting rasburicase administration in both groups. Most adverse events were related to the underlying chemotherapy regimens. Two hypersensitivity reactions, including grade 1/2 pruritus, were considered to be related to rasburicase. Rasburicase is effective and well tolerated for the management of hyperuricemia in Japanese pediatric patients at high risk of developing TLS.

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“…Nonetheless, uricase is able to convert uric acid into allantoin, which has higher solubility and no obvious adverse actions. Thus, uricase becomes a promising drug for handling hyperuricemia (Bomalaski and Clark, 2004;Jeha et al, 2005;Bertrand et al, 2008;Biggers and Scheinfeld, 2008;Sherman et al, 2008).…”

Section: Introductionmentioning

confidence: 98%

A new practical system for evaluating the pharmacological properties of uricase as a potential drug for hyperuricemia

Feng

Yang

et al. 2010

Arch. Pharm. Res.

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The use of uricase-deficient mammals to screen formulations of engineered uricases as potential drugs for hyperuricemia involves heavy costs and presents a technical bottleneck. Herein, a new practical system was investigated to evaluate the pharmacological significance of a bacterial uricase based on its ability to eliminate uric acid in plasma in vitro, its pharmacokinetics in vivo in healthy rats, and the modeled pharmacodynamics in vivo. This uricase, before and after modification with the monomethyl ether of poly(ethylene glycol)-5000, effectively eliminated uric acid in vitro in rabbit plasma, but its action was susceptible to xanthine inhibition. After intravenous injection of the modified uricase without purification, a bi-exponential model fit well to uricase activities in vivo in the plasma of healthy rats; the half-life of the modified uricase was estimated without interference from the unmodified uricase leftover in the sample and was nearly 100-fold longer than that of the unmodified uricase. Using a model of the elimination of uric acid in vivo taking into account of uricase pharmacokinetics and xanthine inhibition, modeled pharmacodynamics supported that the half-life of uricase and its susceptibility to xanthine are crucial for the pharmacological significance of uricase. Hence, this practical system is desirable for doing preliminary screening of formulations of engineered uricases as potential drugs for hyperuricemia.

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SFCE (Société Française de Lutte contre les Cancers et Leucémies de l'Enfant et de l'Adolescent) Recommendations for the Management of Tumor Lysis Syndrome (TLS) With Rasburicase: An Observational Survey

Cited by 18 publications

References 20 publications

Hyperuricemia and tumor lysis syndrome in children with non-Hodgkin’s lymphoma and acute lymphoblastic leukemia

Hyperuricemia and tumor lysis syndrome in children with non-Hodgkin’s lymphoma and acute lymphoblastic leukemia

A study of rasburicase for the management of hyperuricemia in pediatric patients with newly diagnosed hematologic malignancies at high risk for tumor lysis syndrome

A new practical system for evaluating the pharmacological properties of uricase as a potential drug for hyperuricemia

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