Use of single-dose rasburicase in an obese female.
OBJECTIVE
To report the use of single-dose rasburicase in an obese patient.


METHODS
A 53-year-old obese African American woman weighing 136 kg (ideal body weight [IBW] 55 kg) with new-onset chronic myelomonocytic leukemia in leukocytic blast crisis was treated with hydroxyurea 5 g daily. In addition, she received allopurinol 300 mg daily for prevention of tumor lysis syndrome (TLS). The following day, allopurinol was discontinued and rasburicase was administered at a dose of 0.2 mg/kg of IBW for a serum uric acid level of 11.9 mg/dL. The patient's serum uric acid level decreased to 1.9 mg/dL 48 hours after a single dose.


CONCLUSIONS
Rasburicase is indicated for the initial management of elevated plasma uric acid levels in patients with hematologic and solid tumor malignancies who are at risk for TLS. This case is unique because the patient received one dose of rasburicase followed by allopurinol rather than 5 daily doses of rasburicase. Additionally, the dose was based on IBW rather than actual body weight. Efficacy of this approach is apparent from the uric acid levels and the lack of hemodialysis requirements.


CONCLUSIONS
A single dose of rasburicase (based on IBW) followed by allopurinol can effectively prevent TLS based on serum uric acid concentration. This approach resulted in a substantial cost savings.
University of Maryland Medical Center, Baltimore, MD 21201-1595, USA. tarnold@umm.edu
Tamra M
TM
Arnold
Jameson P
JP
Reuter
Bryna S
BS
Delman
Carl B
CB
Shanholtz
D000493:Allopurinol / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D015275:Tumor Lysis Syndrome / Q000209:etiology / Q000517:prevention & control*; D014503:Urate Oxidase / Q000008:administration & dosage / Q000627:therapeutic use*; D014527:Uric Acid / Q000097:blood
D004791:Enzyme Inhibitors; D011994:Recombinant Proteins; C469709:rasburicase; D014527:Uric Acid; D000493:Allopurinol; D014503:Urate Oxidase