title: Pitfalls, prevention, and treatment of hyperuricemia during tumor lysis syndrome in the era of rasburicase (recombinant urate oxidase).
abstract: 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.
authors.affiliation: Oncologia Ematologia Pediatrica, "Lalla Seràgnoli", Clinica Pediatrica, Università degli Studi di Bologna, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pession
authors.forename: Fraia
authors.initials: F
authors.lastname: Melchionda
authors.forename: Claudia
authors.initials: C
authors.lastname: Castellini
references.citation: Am J Clin Oncol. 2000 Oct;23(5):491-3
references.pmid: 11039510
references.citation: Leuk Res. 2005 Apr;29(4):463-5
references.pmid: 15725482
references.citation: Am J Hematol. 1994 Oct;47(2):129-31
references.pmid: 8092128
references.citation: Gene. 1991 Dec 30;109(2):281-4
references.pmid: 1765273
references.citation: Br J Cancer. 1998 Jun;77 Suppl 4:18-20
references.pmid: 9647616
references.citation: Pharmacotherapy. 2006 Feb;26(2):242-7
references.pmid: 16466328
references.citation: Bone Marrow Transplant. 2006 Jun;37(11):997-1001
references.pmid: 16708061
references.citation: Contrib Nephrol. 2005;147:93-104
references.pmid: 15604609
references.citation: Leukemia. 2003 Mar;17(3):499-514
references.pmid: 12646938
references.citation: Leukemia. 2001 Oct;15(10):1505-9
references.pmid: 11587206
references.citation: Ann Pharmacother. 2005 Nov;39(11):1932-5
references.pmid: 16204390
references.citation: Cancer. 1987 Aug 15;60(4):762-4
references.pmid: 3594399
references.citation: Contrib Nephrol. 2005;147:69-79
references.pmid: 15604607
references.citation: Contrib Nephrol. 2005;147:35-46
references.pmid: 15604604
references.citation: Contrib Nephrol. 2005;147:80-92
references.pmid: 15604608
references.citation: J Clin Oncol. 2001 Feb 1;19(3):697-704
references.pmid: 11157020
references.citation: Am J Med Sci. 2002 Mar;323(3):155-7
references.pmid: 11908861
references.citation: Cancer. 1984 Apr 15;53(8):1783-5
references.pmid: 6199103
references.citation: BioDrugs. 2006;20(3):197-9
references.pmid: 16724869
references.citation: Clin Chem. 2003 Aug;49(8):1417-9
references.pmid: 12881465
references.citation: Expert Opin Pharmacother. 2002 Apr;3(4):433-42
references.pmid: 11934348
references.citation: Proc (Bayl Univ Med Cent). 2005 Jul;18(3):275-9
references.pmid: 16200184
references.citation: Semin Oncol. 2000 Jun;27(3):322-34
references.pmid: 10864220
references.citation: Contrib Nephrol. 2005;147:61-68
references.pmid: 15604606
references.citation: Gene. 1992 Dec 1;122(1):139-45
references.pmid: 1452020
references.citation: Ren Fail. 2002 Mar;24(2):227-32
references.pmid: 12071597
references.citation: Int J Hematol. 2004 Jan;79(1):48-51
references.pmid: 14979478
references.citation: J Pediatr. 1986 Aug;109(2):292-8
references.pmid: 3461147
references.citation: Paediatr Drugs. 2001;3(11):783-92
references.pmid: 11735664
references.citation: Am J Health Syst Pharm. 2003 Nov 1;60(21):2213-22; quiz 2223-4
references.pmid: 14619112
references.citation: Pediatr Nephrol. 2007 Jan;22(1):132-5
references.pmid: 17039332
references.citation: J Support Oncol. 2005 Mar-Apr;3(2):117-24
references.pmid: 15796443
references.citation: Int J Med Sci. 2007 Mar 02;4(2):83-93
references.pmid: 17396159
references.citation: Tex Heart Inst J. 2006;33(1):40-7
references.pmid: 16572868
references.citation: Clin Lymphoma. 2003 Mar;3(4):225-32
references.pmid: 12672271
references.citation: Cancer. 1990 Mar 1;65(5):1072-3
references.pmid: 2302658
references.citation: Eur J Haematol. 2005 Dec;75(6):518-21
references.pmid: 16313266
references.citation: Biotechnol Appl Biochem. 2002 Aug;36(1):21-31
references.pmid: 12149119
references.citation: Ann Hematol. 2003 Mar;82(3):160-5
references.pmid: 12634948
references.citation: Br J Haematol. 2004 Oct;127(1):3-11
references.pmid: 15384972
references.citation: Pharmacotherapy. 2006 Jun;26(6):806-12
references.pmid: 16716134
references.citation: Leukemia. 1997 Nov;11(11):1813-6
references.pmid: 9369411
references.citation: Ann Oncol. 2002 May;13(5):789-95
references.pmid: 12075750
references.citation: Cancer Biol Ther. 2006 Dec;5(12):1614-7
references.pmid: 17204864
references.citation: Am J Hematol. 1997 Jan;54(1):85-6
references.pmid: 8980269
references.citation: Cancer. 1989 Aug 1;64(3):738-40
references.pmid: 2472863
references.citation: J Pediatr. 1982 Jan;100(1):152-5
references.pmid: 6948943
references.citation: Blood. 2001 May 15;97(10):2998-3003
references.pmid: 11342423
references.citation: Rev Med Chir Soc Med Nat Iasi. 2002 Oct-Dec;106(4):705-11
references.pmid: 14974215
references.citation: Comp Biochem Physiol B. 1985;81(3):653-9
references.pmid: 3928241
references.citation: Leuk Lymphoma. 2003 Jan;44(1):77-83
references.pmid: 12691145
references.citation: J Nephrol. 2004 Jan-Feb;17(1):50-6
references.pmid: 15151259