Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase

Figures & data

Table 1 Summary of studies compared different doses of rasburicase

Study	Type of study/population	Dose/time	Results/comments
Vadhan-Raj et al^Citation59	Prospective study. Adult patients with hematologic malignancies	Single dose of 0.15 mg/kg versus 0.15 mg/kg daily for 5 days	No difference between two doses
Trifilio et al^Citation60	Retrospective study. Adult patients with hematologic malignancies	Single dose of 3 mg	3 mg dose was effective
Coutsouvelis et al^Citation61	Retrospective study. Adult patients with hematologic malignancies	Single dose of 3 mg	3 mg dose was effective. Small size study
Lee et al^Citation65	Pediatric patients with hematologic malignancies	Single dose of 4.5 mg	4.5 mg dose was effective. Small size study
Patel et al^Citation68	Retrospective study. Adult oncology patients	Single dose of 4.5 mg	4.5 mg dose was effective
McBride et al^Citation70	Retrospective study. Adult oncology patients	Single dose of 3, 6, or 7.5 mg compared with weight-based dose	6 mg dose was effective
Campara et al^Citation62	Retrospective study. Adult patients with hematologic malignancies	Single dose of 0.15 mg/kg	0.15 mg/kg dose was effective
Knoebel et al^Citation64	Retrospective study. Adult patients with hematologic malignancies	Single dose of 0.05 mg/kg	0.15 mg/kg dose was effective. Small size study
Vines et al^Citation67	Retrospective study. Adult patients with hematologic malignancies	Single dose of 4.5 mg	6 mg dose was effective
Reeves et al^Citation66	Prospective study. Adult patients with hematologic malignancies and solid tumors	Single dose of 7.5 mg versus single dose 0.15 mg/kg	No difference between two doses. Small size study

Table 2 Recommendations for prevention and treatment of tumor lysis syndrome

	Low-risk disease	Intermediate-risk disease	High-risk disease
Diagnostic measures	• No specific measures	• Daily monitoring of laboratory abnormalities before and during the first 7 days of anticancer therapy	• At least twice daily monitoring of laboratory abnormalities before and during the first 7 days of anticancer therapy
Preventive measures	• Moderate hydration is recommended	• Vigorous hydration • Keep urinary output >100 mL/h • Treatment with allopurinol or febuxostat should be started at least 24 hours before initiation of anticancer therapy and should be continued till normalization of uric acid levels and signs of large tumor burden are absent	• Vigorous hydration • Keep urinary output >100 mL/h • Single dose 6 mg of rasburicase. Repeat doses as necessary. In case of contraindication treatment with febuxostat
Treatment of established tumor lysis syndrome	• Admission to intensive care unit with continuous cardiac monitoring and monitoring of laboratory abnormalities every 4–6 hours
	• Early nephrology consultation to estimate the indications for renal replacement therapy
	• Correction of electrolyte abnormalities
	• Vigorous hydration, keep urinary output >100 mL/h
	• Single dose 6 mg of rasburicase. Repeat doses as necessary. In case of contraindication, treatment with febuxostat

Vadhan-RajSFayadLEFanaleMAA randomized trial of a single-dose rasburicase versus five-daily doses in patients at risk for tumor lysis syndromeAnn Oncol20122361640164522015451

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TrifilioSMPiJZookJEffectiveness of a single 3-mg rasburicase dose for the management of hyperuricemia in patients with hematological malignanciesBone Marrow Transplant201146680080520818444

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CoutsouvelisJWisemanMHuiLEffectiveness of a single fixed dose of rasburicase 3mg in the management of tumour lysis syndromeBr J Clin Pharmacol201375255055322686734

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LeeACLiCHSoKTChanRTreatment of impending tumor lysis with single-dose rasburicaseAnn Pharmacother200337111614161714565793

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PatelKSLauJEZembillasASGallagherEMSingle 4.5 mg fixed-dose of rasburicase for hyperuricemia associated with tumor lysis syndromeJ Oncol Pharm Pract Epub4152016

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McBrideALathonSCBoehmerLAugustinKMButlerSKWesterveltPComparative evaluation of single fixed dosing and weight-based dosing of rasburicase for tumor lysis syndromePharmacotherapy201333329530323456733

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CamparaMShordSSHaafCMSingle-dose rasburicase for tumour lysis syndrome in adults: weight-based approachJ Clin Pharm Ther200934220721319250141

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KnoebelRWLoMCrankCWEvaluation of a low, weight-based dose of rasburicase in adult patients for the treatment or prophylaxis of tumor lysis syndromeJ Oncol Pharm Pract201117314715420332174

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VinesANShanholtzCBThompsonJLFixed-dose rasburicase 6 mg for hyperuricemia and tumor lysis syndrome in high-risk cancer patientsAnn Pharmacother201044101529153720841516

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ReevesDJBestulDJEvaluation of a single fixed dose of rasburicase 7.5 mg for the treatment of hyperuricemia in adults with cancerPharmacotherapy200828668569018503395

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