Treatment and prevention of tumor lysis syndrome in children. Experience of Associazione Italiana Ematologia Oncologia Pediatrica.
BACKGROUND
Hyperuricemia and tumor lysis syndrome (TLS) are complications that can arise from treatment of rapidly proliferating and drug-sensitive neoplasms. Clinical trials have shown rasburicase, a recombinant urate oxidase to be more effective than allopurinol for the prevention and treatment of malignancy-associated hyperuricemia. We investigated the safety and efficacy of rasburicase in the AIEOP centers' experience.


METHODS
We reviewed the data of 26 children with malignancy at risk for TLS, submitted to treatment (group 1) or prophylaxis (group 2) of acute hyperuricemia with rasburicase (0.20 mg/kg intravenously daily) for a median period of 4 days.


RESULTS
Rasburicase produced a significant decrease in uric acid concentrations in all the patients. The control of uric acid levels was obtained in both the groups within 24 h of the first dose with a response rate of 100% (group 1) and 93% (group 2). Normalization of creatinine and phosphorus levels was obtained in 5 and 4 days respectively. Tolerance was excellent without toxicity.


CONCLUSIONS
These data confirm that rasburicase is a safe, highly and rapidly effective agent in the treatment and prevention of malignancy-associated acute hyperuricemia and could be considered the treatment of choice to prevent tumor lysis syndrome in children at high risk for this metabolic complication.
Pession
Andrea
A
Oncoematologia Pediatrica, Dipartimento di Scienze Pediatriche Mediche e Chirurgiche, Università di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Barbieri
Eveline
E
D058186:Acute Kidney Injury / Q000209:etiology; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015275:Tumor Lysis Syndrome / Q000188:drug therapy* / Q000517:prevention & control; D014503:Urate Oxidase / Q000627:therapeutic use
C469709:rasburicase; D014503:Urate Oxidase