title: Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B-NHL: a Children's Oncology Group Report.
abstract: Laboratory (LTLS) and clinical (CTLS) tumour lysis syndrome (TLS) are frequent complications in newly diagnosed children with advanced mature B cell non-Hodgkin lymphoma (B-NHL). Rasburicase, compared to allopurinol, results in more rapid reduction of uric acid in paediatric patients at risk for TLS. However, the safety and efficacy of rasburicase for the treatment or or prevention of TLS has not been prospectively evaluated. Children with newly diagnosed stage III-IV, bone marrow(+) and/or central nervous system(+) mature B-NHL received hydration and rasburicase prior to cytoreductive therapy. Rasburicase was safe and well-tolerated and there were no grade III-IV toxicities probably or directly related to rasburicase. Patients with an initial lactate dehydrogenase ≥2× upper limit of normal had a significantly elevated uric acid level (P = 0·005), increased incidence of TLS (P-0·005) and lower glomerular filtration rate (GFR; P < 0·001). Following rasburicase, there was only a 9% and 5% incidence of LTLS and CTLS, respectively. Furthermore, there was a significant improvement in estimated GFR from Day 0 to Day 7 following rasburicase (P = 0·0007) and only 1·3% of patients required new onset renal assisted support after rasburicase administration. A TLS strategy incorporating rasburicase prior to cytoreductive chemotherapy proved safe and effective in preventing new onset renal failure and was associated with a significant improvement in GFR.
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Galardy
authors.forename: Jessica
authors.initials: J
authors.lastname: Hochberg
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Perkins
authors.forename: Lauren
authors.initials: L
authors.lastname: Harrison
authors.forename: Stanton
authors.initials: S
authors.lastname: Goldman
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D000293:Adolescent; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects; D033461:Hyperuricemia / Q000209:etiology; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009363:Neoplasm Proteins / Q000097:blood; D010865:Pilot Projects; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D000069283:Rituximab; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000145:classification / Q000517:prevention & control*; D014503:Urate Oxidase / Q000009:adverse effects / Q000627:therapeutic use*; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D009363:Neoplasm Proteins; D003561:Cytarabine; C469709:rasburicase; D000069283:Rituximab; D014750:Vincristine; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D014503:Urate Oxidase; D011241:Prednisone; D006854:Hydrocortisone; D008727:Methotrexate
keywords: Burkitt lymphoma; Rasburicase; diffuse large B-cell lymphoma; paediatric; tumour lysis syndrome
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