Emerging role of rasburicase in the management of increased plasma uric acid levels in patients with hematologic malignancies

Abstract

Tumor lysis syndrome (TLS) is defined as a group of metabolic derangements that result from the massive and abrupt release of cellular components into the bloodstream after rapid lysis of tumor cells. Breakdown of released materials leads to a number of electrolyte abnormalities, including elevated uric acid concentrations in the blood (hyperuricemia), which carries potentially serious consequences. The diagnosis, prevention, and management of TLS is complicated by variability in definitions, differences in risk factors based on patient- and tumor-specific characteristics, and practitioner preferences in terms of pharmaceutical management strategies. The best prevention and management option for a particular patient depends on the patient’s baseline risk for TLS development, the severity of symptoms in the event of TLS development, practical management considerations, and financial implications of treatment.

A Rare Case of Tumor Lysis Syndrome

“…Rasburicase decreases uric acid levels by catalyzing the conversion of uric acid to allantoin, which is more soluble in urine. 15 This is in contrast to allopurinol, a prophylactic medication, which competitively blocks xanthine oxidase, preventing the conversion of purines to uric acid. 16,17 Once TLS is diagnosed, rasburicase is the appropriate therapy to eliminate the excess uric acid.…”

Prevention, diagnosis and treatment of tumor lysis syndrome

“…Prophylaxis of allopurinol should be induced in patients at moderate and high risk of TLS, and its use should be considered in patients at low risk. Prophylaxis with allopurinol should be performed up to three days before the start of chemotherapy [17,19].…”

Fixed-Dose Recombinant Urate Oxidase in the Treatment of Paediatric Tumour Lysis Syndrome: A Regional Cancer Centre Experience

“…Tumor lysis syndrome (TLS) is a metabolic oncologic emergency characterised by the triad of hyperuricemia, hyperphosphatemia and hyperkalemia arising due to the abrupt and massive release of intracellular components into systemic circulation following lysis of malignant tumour cells (Coiffier et al, 2008). Rasburicase, a recombinant urate oxidase (RUO) was approved by FDA for use in Paediatric TLS in the year 2002 at a dose of 0.15-0.2mg/kg as a single daily dose for 5 days (Kennedy et al, 2011). However, the high cost associated with administering the drug at the recommended dose and schedule has discouraged its routine use in managing children with TLS in low-middle income countries like Kidwai Cancer Institute from April 2017 to July 2018 with TLS and treated with a single, fixed -dose (1.5 mg) of RUO was undertaken.…”