Sevelamer hydrochloride: a novel treatment of hyperphosphatemia associated with tumor lysis syndrome in children.
BACKGROUND
Sevelamer is a phosphate-binder used effectively for the treatment of hyperphosphatemia in patients treated with dialysis.


OBJECTIVE
To describe the safety of sevelamer in children with hyperphosphatemia secondary to tumor lysis syndrome and the serum phosphate concentrations observed following its administration.


METHODS
A retrospective chart review of all children with leukemia/lymphoma diagnosed between November 2002 and April 2004 who received sevelamer during their initial admission was conducted. We monitored the effects of sevelamer on serum phosphate concentration, calcium/phosphate product and renal function at hours 24, 48, and 72 from sevelamer initiation.


RESULTS
Thirteen patients received sevelamer during the study period. Their median age was 13 years (range 2.7-17.9) and eight were boys. Nine children had acute lymphoblastic leukemia, one had acute myeloid leukemia and 3 had non-Hodgkin's lymphoma. The most frequently used dose of sevelamer was 400 mg orally twice daily. The median duration of sevelamer therapy was 2 days (range 1-7). Two children were excluded from the efficacy analysis due to concurrent use of dialysis. Mean serum phosphate levels decreased after sevelamer administration, in eleven patients, from a baseline 2.2 mmol/L +/- 0.4 (95% CI, 1.7-3.1) to 1.1 mmol/L +/- 0.2 at hour 72 (95%CI, 0.6-1.5). The only toxicity attributed to sevelamer was mild vomiting in three patients.


CONCLUSIONS
Sevelamer appears to be effective and tolerable for the treatment of hyperphosphatemia associated with tumor lysis syndrome.
Abdullah
Shaker
S
Divisions of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
Diezi
Manuel
M
Sung
Lillian
L
Dupuis
L Lee
LL
Geary
Denis
D
Abla
Oussama
O
D000293:Adolescent; D002130:Calcium Phosphates / Q000097:blood; D002614:Chelating Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D010710:Phosphates / Q000097:blood; D011073:Polyamines / Q000008:administration & dosage* / Q000633:toxicity; D012189:Retrospective Studies; D000069603:Sevelamer; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000150:complications* / Q000188:drug therapy; D014839:Vomiting / Q000139:chemically induced
D002130:Calcium Phosphates; D002614:Chelating Agents; D010710:Phosphates; D011073:Polyamines; C020243:calcium phosphate; D000069603:Sevelamer