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: Paul J Galardy, Jessica Hochberg, Sherrie L Perkins, Lauren Harrison, Stanton Goldman, Mitchell S Cairo
• Journal: British journal of haematology (Br J Haematol) Vol. 163 Issue 3 Pg. 365-72 (Nov 2013) ISSN: 1365-2141 [Electronic] England
• PMID: 24032600 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 John Wiley & Sons Ltd.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Neoplasm Proteins
• Cytarabine
• rasburicase
• Rituximab
• Vincristine
• Cyclophosphamide
• L-Lactate Dehydrogenase
• Urate Oxidase
• Prednisone
• Hydrocortisone
• Methotrexate

Topics

• Acute Kidney Injury (etiology, prevention & control)
• Adolescent
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Child
• Child, Preschool
• Cyclophosphamide (administration & dosage, adverse effects)
• Cytarabine (administration & dosage, adverse effects)
• Female
• Humans
• Hydrocortisone (administration & dosage, adverse effects)
• Hyperuricemia (etiology)
• Infant
• L-Lactate Dehydrogenase (blood)
• Lymphoma, B-Cell (complications, drug therapy, therapy)
• Lymphoma, Non-Hodgkin (complications, drug therapy, therapy)
• Male
• Methotrexate (administration & dosage, adverse effects)
• Neoplasm Proteins (blood)
• Pilot Projects
• Prednisone (administration & dosage, adverse effects)
• Prospective Studies
• Rituximab
• Tumor Lysis Syndrome (blood, classification, prevention & control)
• Urate Oxidase (adverse effects, therapeutic use)
• Vincristine (administration & dosage, adverse effects)
• Young Adult