Tumor Lysis Syndrome: A Systematic Review of Case Series and Case Reports

Firwana, Belal; Hasan, Rim; Hasan, Nour; Alahdab, Fares; Alnahhas, Iyad; Hasan, Somar; Varon, Joseph

doi:10.3810/pgm.2012.03.2540

Cited by 34 publications

(47 citation statements)

References 141 publications

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“…In total, 39 out of 40 (98%) patients in the daily-dose arm and 34 out of 40 (85%) patients in the single-dose arm demonstrated a sustained S-UA response, although six patients within the single-dose arm required a second dose for S-UA levels >7.5 mg/dl (19). Cortes et al (20) compared the UA-lowering efficacy between rasburicase at a dose of 0.2 mg/kg (days 1-5), rasburicase plus allopurinol at a rasburicase dose of 0.2 mg/kg (days 1-3) and an allopurinol dose of 300 mg (days [3][4][5], and allopurinol at a dose of 300 mg (days 1-5) for patients at risk of TLS, using a prospective study design (20). The UA response rate was defined as the percentage of patients achieving or maintaining S-UA ≤7.5 mg/dl during days 3-7.…”

Section: Discussionmentioning

confidence: 99%

“…The risk classification for TLS was made based on previously reported guidelines (2). Diseases at an intermediate risk for TLS consisted of acute myeloid leukemia with a peripheral white blood cell count between 1x10 4 and 5x10 4 cells/µl, acute lymphoblastic leukemia with a peripheral white blood cell count between 5x10 4 and 1x10 5 cells/µl, diffuse large B cell non-Hodgkin's lymphoma, and other hematological malignancies that would proliferate rapidly with expected rapid response to therapy (2). Diseases at a high risk included acute monoblastic leukemia, acute myeloid leukemia with a peripheral white blood cell count ≥5x10 4 cells/µl, and acute lymphoblastic leukemia with a peripheral white blood cell count ≥1x10 5 cells/µl (2).…”

Section: Patientsmentioning

confidence: 99%

“…The management of TLS includes aggressive hydration and a reduction in the serum UA (S-UA) level through the administration of drugs that decrease the production of UA or degrade UA (2,3,5,6). Hyperuricemia results from the rapid catabolism of purine-containing nucleic acids from cancer cells, since purine nucleotides are converted to hypoxanthine, xanthine, and finally to UA by xanthine oxidase (6).…”

Section: Introductionmentioning

confidence: 99%

“…The cell lysis leads to the rapid release of intracellular metabolites, including nucleic acids, proteins, phosphorus and potassium. This process can potentially cause hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia, thereby inducing renal insufficiency, cardiac arrhythmias, seizures and neurological disorders, ultimately resulting in mortality (1)(2)(3)(4)(5)(6). However, TLS is preventable at an early stage, and it is essential to identify patients at risk of TLS and those requiring TLS management (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…Tumor lysis syndrome (TLS) is a life-threatening oncological emergency that is caused by the abrupt and massive lysis of cancer cells (1)(2)(3)(4)(5)(6). The cell lysis leads to the rapid release of intracellular metabolites, including nucleic acids, proteins, phosphorus and potassium.…”

Section: Introductionmentioning

confidence: 99%

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Reduced administration of rasburicase for tumor lysis syndrome: A single-institution experience

et al. 2015

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Abstract. In the present study, the dosage and duration of rasburicase administration were retrospectively evaluated for the ability to control the serum uric acid (S-UA) level in 13 patients diagnosed with hematological malignancies and tumor lysis syndrome (TLS), or those at risk of developing TLS, at the University of Fukui Hospital. At the time of diagnosis, seven patients already exhibited laboratory TLS, and three demonstrated clinical TLS. All patients received rasburicase in addition to chemotherapy agents. The median dose was 0.19 mg/kg (range, 0.13-0.25 mg/kg), and the median duration was four days (range, 1-7 days). Six patients sequentially received a xanthine oxidase inhibitor, allopurinol or febuxostat. The primary estimate was the normalization of the S-UA level at the end of rasburicase treatment and on treatment day seven. The average S-UA level prior to treatment was 10.4±4.5 mg/dl (mean ±standard deviation), and 11 out of 13 patients demonstrated a S-UA level >7 mg/dl. The S-UA level at the end of rasburicase administration was 0.5±1.5 mg/dl and the S-UA level at day seven was 1.4±1.5 mg/dl. All the patients achieved normalization of the S-UA level. On day seven subsequent to the initiation of treatment, the patients receiving rasburicase for a maximum of three days exhibited an S-UA level of 1.9±1.8 mg/dl, while the patients receiving rasburicase for longer than three days demonstrated an S-UA level of 1.0±1.3 mg/dl (P=0.20; Mann-Whitney test). The administration of 0.13 mg/kg and 0.22 mg/kg resulted in comparable UA level reductions. The administration of allopurinol or febuxostat following rasburicase administration suppressed the re-increase in S-UA level. Therefore, it was concluded that reduced administration of rasburicase successfully controlled the S-UA level in TLS.

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