Low-dose Rasburicase in Hematologic Malignancies

• Published in: Indian journal of pediatrics Vol. 82; no. 5; pp. 458 - 461
• Main Authors: Jayabose, Somasundaram, Kumar, Vignesh, Dhanabalan, Rajeswari, Rajan, Priya, Rathnam, Krishnakumar, Viswanathan, T. Kasi
• Format: Journal Article
• Language: English
• Published: India Springer India 01.05.2015
• Subjects: Adolescent; Child; Child, Preschool; Female; Gout Suppressants - administration & dosage; Gout Suppressants - adverse effects; Gynecology; Hematologic Neoplasms - drug therapy; Humans; India; Infant; Male; Medicine; Medicine & Public Health; Original Article; Pediatrics; Retrospective Studies; Tumor Lysis Syndrome - drug therapy; Urate Oxidase - administration & dosage; Urate Oxidase - adverse effects; Uric Acid - blood; Young Adult; Hyperphosphatemia; Hyperuricemia; Rasburicase; Tumor lysis syndrome; Lymphoma; Leukemia
• ISSN: 0019-5456; 0973-7693
• DOI: 10.1007/s12098-014-1606-1

Objective To define the efficacy and safety of low-dose rasburicase in children from south India with hematologic malignancies. Methods This study is a retrospective analysis of data on 41 children with hematologic malignacies with laboratory evidence of tumor lysis syndrome (TLS) or clinical features indicating high risk for developing TLS. Patients were treated with rasburicase in doses of 0.1–0.15 mg/kg dose, repeated when necessary. Results Male : Female ratio was 32:9. Thirty-six children had laboratory evidence of TLS and 5 were at risk for TLS. Diagnoses were T-cell acute lymphoblastic leukemia (ALL), 19; Pre-B ALL, 17; B-non-Hodgkin lymphoma (NHL), 2; T-NHL, 2; and acute myeloid leukemia (AML), 1. Initial plasma uric acid (PUA): median, 8.5 mg/dl (range, 4.3 to 45.5). Six had creatinine levels of >2 mg/dl on admission; and 10 had peak PO 4 levels of >10 mg/dl. Dose of rasburicase used: median, 0.12 mg/kg (range, 0.08–0.24). Median reduction of PUA at 6 h: 80 % (range 40 to 98 %). Twenty-seven needed only one dose; 12 needed 2 or 3 doses; and two needed 5 doses each. One child required dialysis. None of the children developed anaphylaxis or hemolysis and there were no deaths from TLS. Conclusions Low-dose rasburicase (0.1–0.15 mg/kg) is safe and effective in reducing PUA in Indian children with lymphoid malignancies, and thus it may reduce the risk of renal failure from TLS.