Efficacy of Fixed Low Dose Rasburicase in the Prevention and Treatment of Tumor Lysis Syndrome

Antony, Remya; Lakshmi, Sandhya; Sivadas, Akhila; Jose, Wesley; Sidharthan, Neeraj; Pavithran, K.

doi:10.18579/jpcrkc/2015/0/0/79203

Cited by 3 publications

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“…Studies from India have used single dose based on body weight and with small sample size in the pediatric age group [10,16,17]. Our study shows similar results to another study from India using single 1.5 mg fixed dose of rasburicase [11]. In the group with clinical TLS the median dose of rasburicase delivered per case was 2.…”

Section: Discussionsupporting

confidence: 84%

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Efficacy of Single Dose Rasburicase (1.5 mg) for Prophylaxis and Management of Laboratory Tumor Lysis Syndrome

Philips

Radhakrishnan

Ganesan

et al. 2018

Indian J Hematol Blood Transfus

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Rasburicase is a recombinant urate oxidase enzyme approved for use in tumor lysis syndrome (TLS) and it acts by reducing serum uric acid levels. Using rasburicase at the recommended dose of 0.2 mg/kg/day for 5 days is expensive and it is not known whether this extended schedule is clinically beneficial compared to a single fixed dose of 1.5 mg. The aim of the present study was to evaluate the efficacy of single dose rasburicase 1.5 mg in prevention and management of TLS. Rasburicase is available as single use 1.5 mg vial. At our institution a single dose of rasburicase 1.5 mg irrespective of bodyweight has been used in adults and in children a dose of 0.15 mg/kg (maximum 1.5 mg) has been used since 2012 for prevention and management of TLS and subsequent doses are given based on biochemical response and clinical condition. We retrospectively analysed the case records of patients who had received rasburicase from January 2012 to January 2017. The study included 186 patients with hematological malignancies who received rasburicase. Children accounted for 56.4% (n = 105) patients and males comprised 73% (n = 135). Rasburicase was used prophylactically in 59 (31.7%) patients, for laboratory TLS in 76 patients (40.8%) and for clinical TLS in 51 (27.4%) patients. Single fixed dose rasburicase prevented laboratory/clinical TLS in 87% of the prophylactic group and prevented clinical TLS in 72% of the laboratory TLS group. None of the patients in prophylactic and laboratory TLS group developed clinical TLS. However, majority of the patients with clinical TLS required more than one dose rasburicase. Single dose of 1.5 mg (1 vial) rasburicase is efficient in preventing and managing laboratory TLS and is economically viable in resource constrained settings.

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Section: Discussionsupporting

confidence: 84%

“…The recommended dose of rasburicase is 0.15-0.2 mg/kg per day for 5 days for TLS management. Studies have shown much lesser doses to be effective in preventing TLS [5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Single Dose Rasburicase (1.5 mg) for Prophylaxis and Management of Laboratory Tumor Lysis Syndrome

Philips

Radhakrishnan

Ganesan

et al. 2018

Indian J Hematol Blood Transfus

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A phase 2 trial of single low doses of rasburicase for treatment of hyperuricemia in adult patients with acute leukemia

et al. 2021

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Follow-Up Study on Management of Tumour Lysis Syndrome with Single Low Fixed Dose (1.5 mg) of Rasburicase - A Tertiary Cancer Centre Experience from India

Ranjan¹,

Khanna²,

Ranjan³

et al. 2021

jebmh

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BACKGROUND Rasburicase (recombinant urate oxidase) has been proven to be an effective therapy for prevention of tumour lysis syndrome (TLS). The recommended daily dosing regimen of rasburicase is 0.2 mg/kg/day for 5 days which is expensive and unaffordable to many patients in the developing countries. The purpose of the present study was to evaluate the effect of single 1.5 mg dose rasburicase in the management of tumour lysis syndrome. METHODS This is a follow-up study done at our institute. Fifty (50) patients with tumour lysis syndrome who received rasburicase from August 2015 to January 2020 were enrolled in this study RESULTS Single dose of rasburicase is effective in decreasing serum uric acid level in significant number (N = 41) of patients. Percentage of patients having uric acid less than 7 mg after single dose of rasburicase in 48 hours - 82.9 % (N = 34) while 17 % (N = 7) were found to have uric acid levels of more than 7 mg/dl. The percentage of patients with uric acid levels more than 7 mg/dl reduced from 36.5 % after 24 hours to 17 % after 48 hours. This indicates that the uric acid levels show a declining trend even after 24 hours without giving an additional dose of rasburicase. There was no relationship between uric acid levels at 24 hours and percentage change in creatinine level from baseline to 24 hours (correlation coefficient (r) = -0.047, P = 0.770. Patients who required additional dose (N = 9) had high base line value of uric acid and their high value was maintained over the follow up period of three days. Patients with pre exiting kidney disease and high level of baseline uric acid also needed dialysis (N = 3). CONCLUSIONS In majority of patients, a single 1.5 mg dose of rasburicase is an effective way to reduce raised uric acid in appropriate circumstances. KEYWORDS Single Dose, Recombinant Urate Oxidase, Uric Acid, Leukemia, Tumour Lysis Syndrome, Rasburicase

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Efficacy of Fixed Low Dose Rasburicase in the Prevention and Treatment of Tumor Lysis Syndrome

Cited by 3 publications

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Efficacy of Single Dose Rasburicase (1.5 mg) for Prophylaxis and Management of Laboratory Tumor Lysis Syndrome

Efficacy of Single Dose Rasburicase (1.5 mg) for Prophylaxis and Management of Laboratory Tumor Lysis Syndrome

A phase 2 trial of single low doses of rasburicase for treatment of hyperuricemia in adult patients with acute leukemia

Follow-Up Study on Management of Tumour Lysis Syndrome with Single Low Fixed Dose (1.5 mg) of Rasburicase - A Tertiary Cancer Centre Experience from India

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