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

Takai,Mihoko; Yamauchi,Takahiro; Matsuda,Yasufumi; Tai,Katsunori; Ikegaya,Satoshi; Kishi,Shinji; Urasaki,Yoshimasa; Yoshida,Akira; Iwasaki,Hiromichi; Ueda,Takanori

doi:10.3892/ol.2015.3009

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

Authors:
- Mihoko Takai
- Takahiro Yamauchi
- Yasufumi Matsuda
- Katsunori Tai
- Satoshi Ikegaya
- Shinji Kishi
- Yoshimasa Urasaki
- Akira Yoshida
- Hiromichi Iwasaki
- Takanori Ueda
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Affiliations: Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910‑1193, Japan, Division of Infection Control, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910‑1193, Japan
Published online on: March 3, 2015 https://doi.org/10.3892/ol.2015.3009
Pages: 2119-2125

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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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1	Cairo MS and Bishop M: Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 127:3–11. 2004. View Article : Google Scholar : PubMed/NCBI
2	Coiffier B, Altman A, Pui CH, Younes A and Cairo MS: Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 26:2767–2778. 2008. View Article : Google Scholar : PubMed/NCBI
3	Cairo MS, Coiffier B, Reiter A and Younes A: TLS expert panel: Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 149:578–586. 2010. View Article : Google Scholar : PubMed/NCBI
4	Howard SC, Jones DP and Pui CH: The tumor lysis syndrome. N Engl J Med. 364:1844–1854. 2011. View Article : Google Scholar : PubMed/NCBI
5	Firwana BM, Hasan R, Hasan N, Alahdab F, Alnahhas I, Hasan S and Varon J: Tumor lysis syndrome: a systematic review of case series and case reports. Postgrad Med. 124:92–101. 2012. View Article : Google Scholar : PubMed/NCBI
6	Wilson FP and Berns JS: Onco-nephrology: tumor lysis syndrome. Clin J Am Soc Nephrol. 7:1730–1739. 2012. View Article : Google Scholar : PubMed/NCBI
7	Pui CH, Mahmoud HH, Wiley JM, Woods GM, Leverger G, Camitta B, Hastings C, Blaney SM, Relling MV and Reaman GH: Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma. J Clin Oncol. 19:697–704. 2001.PubMed/NCBI
8	McDonnel AM, Lenz KL, Frei-Lahr DA, Hayslip J and Hall PD: Single-dose rasburicase 6 mg in the management of tumor lysis syndrome in adults. Pharmacotherapy. 26:806–812. 2006. View Article : Google Scholar : PubMed/NCBI
9	Cammalleri L and Malaguarnera M: Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci. 4:83–93. 2007. View Article : Google Scholar : PubMed/NCBI
10	Cheuk DK, Chiang AK, Chan GC and Ha SY: Urate oxidase for the prevention and treatment of tumor lysis syndrome in children with cancer. Cochrane Database Syst Rev. 16:CD0069452010.
11	Ishizawa K, Ogura M, Hamaguchi M, Hotta T, Ohnishi K, Sasaki T, Sakamaki H, Yokoyama H, Harigae H and Morishima Y: Safety and efficacy of rasburicase (SR29142) in a Japanese phase II study. Cancer Sci. 100:357–62. 2009. View Article : Google Scholar : PubMed/NCBI
12	Trifilio S, Gordon L, Singhal S, Tallman M, Evens A, Rashid K, Fishman M, Masino K, Pi J and Mehta J: Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia. Bone Marrow Transplant. 37:997–1001. 2006. View Article : Google Scholar : PubMed/NCBI
13	Jeha S, Kantarjian H, Irwin D, Shen V, Shenoy S, Blaney S, Camitta B and Pui CH: Efficacy and safety of rasburicase, a recombinant urate oxidase (Elitek), in the management of malignancy associated hyperuricemia in pediatric and adult patients: Final results of a multicenter compassionate use trial. Leukemia. 19:34–38. 2005.PubMed/NCBI
14	The guideline revising committee of Japanese Society of Gout and Nucleic Acid Metabolism. Digest of the guideline for management of hyperuricemia and gout. 2nd edition. Gout Nucleic Acid Metabol. 34:107–143. 2010.(In Japanese). View Article : Google Scholar
15	Yamauchi T, Negoro E, Lee S, Takai M, Matsuda Y, Takagi K, Kishi S, Tai K, Hosono N, Tasaki T, Ikegaya S, Inai K, Yoshida A, Urasaki Y, Iwasaki H and Ueda T: A high serum uric acid level is associated with poor prognosis in patients with acute myeloid leukemia. Anticancer Res. 33:3947–3951. 2013.PubMed/NCBI
16	Yeldandi AV, Yeldandi V, Kumar S, Murthy CV, Wang XD, Alvares K, Rao MS and Reddy JK: Molecular evolution of the urate oxidase-encoding gene in hominoid primates: Nonsense mutations. Gene. 109:281–284. 1991. View Article : Google Scholar : PubMed/NCBI
17	Ishizawa K, Ogura M, Hamaguchi M, Hotta T, Ohnishi K, Sasaki T, Sakamaki H, Yokoyama H, Harigae H and Morishima Y: Safety and efficacy of rasburicase (SR29142) in a Japanese phase II study. Cancer Sci. 100:357–362. 2009. View Article : Google Scholar : PubMed/NCBI
18	McBride A, Lathon SC, Boehmer L, Augustin KM, Butler SK and Westervelt P: Comparative evaluation of single fixed dosing and weight-based dosing of rasburicase for tumor lysis syndrome. Pharmacotherapy. 33:295–303. 2013. View Article : Google Scholar : PubMed/NCBI
19	Vadhan-Raj S, Fayad LE, Fanale MA, Pro B, Rodriguez A, Hagemeister FB, Bueso-Ramos CE, Zhou X, McLaughlin PW, Fowler N, Shah J, Orlowski RZ, Samaniego F, Wang M, Cortes JE, Younes A, Kwak LW, Sarlis NJ and Romaguera JE: A randomized trial of a single-dose rasburicase versus five-daily doses in patients at risk for tumor lysis syndrome. Ann Oncol. 23:1640–1645. 2012. View Article : Google Scholar : PubMed/NCBI
20	Cortes J, Moore JO, Maziarz RT, Wetzler M, Craig M, Matous J, Luger S, Dey BR, Schiller GJ, Pham D, Abboud CN, Krishnamurthy M, Brown A Jr, Laadem A and Seiter K: 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. J Clin Oncol. 28:4207–4213. 2010. View Article : Google Scholar : PubMed/NCBI