The optimal single‐dose regimen of rasburicase for management of tumour lysis syndrome in children and adults: a systematic review and meta‐analysis

Summary What is known and objective To perform a meta‐analysis exploring the optimal single‐dose regimen for managing tumour lysis syndrome ( TLS ) in children and adults with haematological malignancies. Methods We systematically searched PubMed, MEDLINE , Web of Science, the Cochrane Library and the ClinicalTrials.gov website for studies regarding single‐dose rasburicase in paediatric and adult patients with TLS . Data were analysed using Open MetaAnalyst statistical software. Results Fifteen adult studies (fourteen retrospective studies and one randomized controlled trial) and four observational studies using children were extracted, with a total of 906 and 92 subjects, respectively. Single doses of 1·5, 3, 4·5, 6, 7·5 mg and weight‐based single doses of 0·05 and 0·15 mg/kg were compared. The response rate for 6, 7·5 mg and 0·15 mg/kg single doses was 90% (95% CI : 0·825–0·974), 98·6% (95% CI : 0·957–1·015) and 93·6% (95% CI : 0·864–1·007), respectively, and higher than other dosing regimens tested. The single doses of 6 mg and 0·15 mg/kg rasburicase decreased uric acid levels more than the other regimens, and the mean uric acid reduction was 8·45 mg/ dL (95% CI , 7·51–9·38) and 10 mg/ dL (95% CI , 8·58–11·42), respectively. What is new and conclusion Our meta‐analysis revealed that, for adult patients, a single 6 mg rasburicase dose is sufficient to normalize and sustain lower uric acid and creatinine levels in adults with TLS . This dose, therefore, balances cost and efficacy of treatment. The 3‐ and 4·5‐mg single dose can be considered if the baseline uric acid level <12 mg/dL, with close monitoring of clinical and biochemical parameters, and repeat dosing if required. The 1·5 mg and 0·15 mg/kg single dose were sufficient to manage TLS in children.