Pitfalls, prevention, and treatment of hyperuricemia during tumor lysis syndrome in the era of rasburicase (recombinant urate oxidase).
Along with hydration and urinary alkalinization, allopurinol has been the standard agent for the management of hyperuricemia in patients with a high tumor burden at risk of tumor lysis syndrome; however, this agent often fails to prevent and treat this complication effectively. Rasburicase (recombinant urate oxidase) has been shown to be effective in reducing uric acid and preventing uric acid accumulation in patients with hematologic malignancies with hyperuricemia or at high risk of developing it. Rasburicase acts at the end of the purine catabolic pathway and, unlike allopurinol, does not induce accumulation of xanthine or hypoxanthine. Its rapid onset of action and the ability to lower pre-existing elevated uric acid levels are the advantages of rasburicase over allopurinol. Rasburicase represents an effective alternative to allopurinol to promptly reduce uric acid levels, improve patient's electrolyte status, and reverse renal insufficiency. The drug, initially studied in pediatric patients with acute lymphoblastic leukemia and aggressive non-Hodgkin lymphoma, seems to show comparable benefit in adults with similar lymphoid malignancies or at high risk of tumor lysis syndrome. Current and future trials will evaluate alternative doses and different schedules of rasburicase to maintain its efficacy while reducing its cost. The review provides a comprehensive and detailed review of pathogenesis, laboratory, and clinical presentation of TLS together with clinical studies already performed both in pediatric and adult patients.
Pession
Andrea
A
Oncologia Ematologia Pediatrica, "Lalla Seràgnoli", Clinica Pediatrica, Università degli Studi di Bologna, Bologna, Italy.
Melchionda
Fraia
F
Castellini
Claudia
C
Am J Clin Oncol. 2000 Oct;23(5):491-3
11039510
Leuk Res. 2005 Apr;29(4):463-5
15725482
Am J Hematol. 1994 Oct;47(2):129-31
8092128
Gene. 1991 Dec 30;109(2):281-4
1765273
Br J Cancer. 1998 Jun;77 Suppl 4:18-20
9647616
Pharmacotherapy. 2006 Feb;26(2):242-7
16466328
Bone Marrow Transplant. 2006 Jun;37(11):997-1001
16708061
Contrib Nephrol. 2005;147:93-104
15604609
Leukemia. 2003 Mar;17(3):499-514
12646938
Leukemia. 2001 Oct;15(10):1505-9
11587206
Ann Pharmacother. 2005 Nov;39(11):1932-5
16204390
Cancer. 1987 Aug 15;60(4):762-4
3594399
Contrib Nephrol. 2005;147:69-79
15604607
Contrib Nephrol. 2005;147:35-46
15604604
Contrib Nephrol. 2005;147:80-92
15604608
J Clin Oncol. 2001 Feb 1;19(3):697-704
11157020
Am J Med Sci. 2002 Mar;323(3):155-7
11908861
Cancer. 1984 Apr 15;53(8):1783-5
6199103
BioDrugs. 2006;20(3):197-9
16724869
Clin Chem. 2003 Aug;49(8):1417-9
12881465
Expert Opin Pharmacother. 2002 Apr;3(4):433-42
11934348
Proc (Bayl Univ Med Cent). 2005 Jul;18(3):275-9
16200184
Semin Oncol. 2000 Jun;27(3):322-34
10864220
Contrib Nephrol. 2005;147:61-68
15604606
Gene. 1992 Dec 1;122(1):139-45
1452020
Ren Fail. 2002 Mar;24(2):227-32
12071597
Int J Hematol. 2004 Jan;79(1):48-51
14979478
J Pediatr. 1986 Aug;109(2):292-8
3461147
Paediatr Drugs. 2001;3(11):783-92
11735664
Am J Health Syst Pharm. 2003 Nov 1;60(21):2213-22; quiz 2223-4
14619112
Pediatr Nephrol. 2007 Jan;22(1):132-5
17039332
J Support Oncol. 2005 Mar-Apr;3(2):117-24
15796443
Int J Med Sci. 2007 Mar 02;4(2):83-93
17396159
Tex Heart Inst J. 2006;33(1):40-7
16572868
Clin Lymphoma. 2003 Mar;3(4):225-32
12672271
Cancer. 1990 Mar 1;65(5):1072-3
2302658
Eur J Haematol. 2005 Dec;75(6):518-21
16313266
Biotechnol Appl Biochem. 2002 Aug;36(1):21-31
12149119
Ann Hematol. 2003 Mar;82(3):160-5
12634948
Br J Haematol. 2004 Oct;127(1):3-11
15384972
Pharmacotherapy. 2006 Jun;26(6):806-12
16716134
Leukemia. 1997 Nov;11(11):1813-6
9369411
Ann Oncol. 2002 May;13(5):789-95
12075750
Cancer Biol Ther. 2006 Dec;5(12):1614-7
17204864
Am J Hematol. 1997 Jan;54(1):85-6
8980269
Cancer. 1989 Aug 1;64(3):738-40
2472863
J Pediatr. 1982 Jan;100(1):152-5
6948943
Blood. 2001 May 15;97(10):2998-3003
11342423
Rev Med Chir Soc Med Nat Iasi. 2002 Oct-Dec;106(4):705-11
14974215
Comp Biochem Physiol B. 1985;81(3):653-9
3928241
Leuk Lymphoma. 2003 Jan;44(1):77-83
12691145
J Nephrol. 2004 Jan-Feb;17(1):50-6
15151259