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Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B ‐ NHL : a C hildren's O ncology G roup R eport
Author(s) -
Galardy Paul J.,
Hochberg Jessica,
Perkins Sherrie L.,
Harrison Lauren,
Goldman Stanton,
Cairo Mitchell S.
Publication year - 2013
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12542
Subject(s) - rasburicase , tumor lysis syndrome , medicine , allopurinol , uric acid , lactate dehydrogenase , gastroenterology , urate oxidase , urology , lymphoma , chemotherapy , surgery , biology , enzyme , biochemistry
Summary Laboratory ( LTLS ) and clinical ( CTLS ) tumour lysis syndrome ( TLS ) are frequent complications in newly diagnosed children with advanced mature B cell non‐Hodgkin lymphoma ( B ‐ NHL ). Rasburicase, compared to allopurinol, results in more rapid reduction of uric acid in paediatric patients at risk for TLS . However, the safety and efficacy of rasburicase for the treatment or or prevention of TLS has not been prospectively evaluated. Children with newly diagnosed stage III ‐ IV , bone marrow + and/or central nervous system + mature B ‐ NHL received hydration and rasburicase prior to cytoreductive therapy. Rasburicase was safe and well‐tolerated and there were no grade III–IV toxicities probably or directly related to rasburicase. Patients with an initial lactate dehydrogenase ≥2× upper limit of normal had a significantly elevated uric acid level ( P = 0·005), increased incidence of TLS ( P −0·005) and lower glomerular filtration rate ( GFR ; P < 0·001). Following rasburicase, there was only a 9% and 5% incidence of LTLS and CTLS , respectively. Furthermore, there was a significant improvement in estimated GFR from D ay 0 to D ay 7 following rasburicase ( P = 0·0007) and only 1·3% of patients required new onset renal assisted support after rasburicase administration. A TLS strategy incorporating rasburicase prior to cytoreductive chemotherapy proved safe and effective in preventing new onset renal failure and was associated with a significant improvement in GFR .