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Oncological emergencies
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Rasburicase is an enzyme which oxidizes uric acid to allantoin, thereby resulting in rapid clearance of uric acid. It is indicated in patients with a high risk of tumour lysis providing greater protection against tumour lysis syndrome than allopurinol. It is particularly indicated in those with acute leukaemias, Burkitt lymphoma, chemosensitive paediatric tumours and other groups with renal impairment. It should be given prior to chemotherapy and daily for up to 7 days.
Case 55
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
He should be well hydrated with intravenous fluids and given rasburicase (after excluding the presence of glucose-6-phosphate dehydrogenase [G6PD] deficiency). This compound metabolises uric acid rapidly and is effective at preventing tumour lysis syndrome in high-risk settings. Allopurinol, which blocks the enzyme xanthine oxidase in the liver, also prevents treatment-induced gout and urate nephropathy. Urinary alkalinisation by use of intravenous sodium bicarbonate promotes excretion of harmful metabolites. A good urine output (more than 3 L daily) should be promoted during therapy.
Lymphomas
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Renal failure (from uric acid nephropathy) and hyperkalaemia are findings of tumour lysis syndrome. Although tumour lysis syndrome can occur with other malignancies, it is most commonly seen with Burkitt’s lymphoma. The rapid doubling time of the tumour results in prolific cell turnover, and intracellular contents such as nucleic acids, potassium and phosphorus spill into the circulation. Nucleic acids are broken down into uric acid, which crystallises within the kidneys and can lead to acute renal insufficiency. Treatment for the tumour lysis syndrome includes aggressive hydration, alkalinisation of urine and allopurinol. Rasburicase can be used to rapidly decrease uric acid levels when needed. Patients are at the highest risk of complications in the days following chemotherapy, because of the rapid killing of tumour cells.
Supportive care in pediatric acute myeloid leukemia:Expert-based recommendations of the NOPHO-DB-SHIP consortium
Published in Expert Review of Anticancer Therapy, 2022
Nira Arad-Cohen, Bernward Zeller, Jonas Abrahamsson, Jose Maria Fernandez Navarro, Daniel Cheuk, Sauli Palmu, Vitor Costa, Barbara De Moerloose, Henrik Hasle, Kirsi Jahnukainen, Cornelis Jan Pronk, Ólafur Gísli Jónsson, Zhanna Kovalova, Birgitte Lausen, Monica Munthe-Kaas, Ulrika Noren-Nyström, Josefine Palle, Ramune Pasauliene, Kadri Saks, Gertjan JL Kaspers
Increased risk of TLS in AML occurs in patients with WBC > 50–100 x 109/L, organomegaly, preexisting hyperuricemia, LDH ≥ 2xUNL (upper normal limit), increased creatinine, renal and/or urinary tract disorders, severe dehydration and FAB-M5. The mainstay of treatment is the recognition and prophylactic measures to prevent its occurrence. Allopurinol is a xanthine oxidase inhibitor that blocks the metabolism of hypoxanthine and xanthine to uric acid, thus decreasing the formation of new uric acid and reducing the incidence of obstructive uropathy. The drug is inexpensive and can be given orally and is therefore preferred in most patients. Rasburicase, a recombinant urate oxidase, metabolizes urate rapidly to allantoin, which is approximately five to ten times more soluble than uric acid. It is given intravenously, is highly effective, and allows starting chemotherapy earlier than
Recent approaches to gout drug discovery: an update
Published in Expert Opinion on Drug Discovery, 2020
Naoyuki Otani, Motoshi Ouchi, Hideo Kudo, Shuichi Tsuruoka, Ichiro Hisatome, Naohiko Anzai
Rasburicase is a recombinant protein expressed by introducing urate oxidase cDNA derived from Aspergillus flavus into Saccharomyces cerevisiae. Numerous studies have demonstrated that rasburicase is effective and safe in reducing urate levels and works within 4 h post‐administration [64–68]. Rasburicase received approval in Europe in 2001 for the prevention of TLS in children and adults [69]. It was approved in the US in 2002 for children, and in 2009 for adults. In Japan, it was approved in 2009 for treating hyperuricemia associated with cancer chemotherapy in children and adults. The dose recommended by the FDA is 0 · 2 mg/kg once daily for up to 5 days. However, there is still not enough evidence for an optimal rasburicase dose regimen in adults and children with TLS.
Transformation of CMML to AML presenting with acute kidney injury
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Rebecca DeBoer, Ian Garrahy, Andrew Rettew, Robert Libera
The etiology of his AKI was likely multifactorial. We postulate that lysozymuria and hyperuricemia both played a role in his progressive renal decline. Further supporting hyperuricemia and lysozymuria as causes of our patient’s AKI was his dramatic improvement in kidney function with treatment of his hyperuricemia and leukocytosis. Two days later after a single dose of rasburicase and being started on hydroxyurea 1000 mg twice daily, creatinine decreased to 1.98 mg/dL from 2.94 mg/dL while uric acid and white blood cells decreased to 5.5 mg/dL and 48.5 × 103 cells per mm3 respectively. Rasburicase is safe and highly effective for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma [15]. As lysozymuria is hypothesized to be from the high concentration of circulating monocytes, the cytoreductive therapy with hydroxyurea would be expected to reduce lysozymuria and hence improve renal function.