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Urate metabolism during bone marrow transplantation.

P K Cannell1, R P Herrmann

  • 1Haematology Department, Royal Perth Hospital, Western Australia.

Bone Marrow Transplantation
|October 1, 1992
PubMed
Summary

Bone marrow transplantation (BMT) can be safely performed without allopurinol in patients with low tumor burden, provided adequate hydration is maintained. Urate excretion remains elevated for 72 hours post-conditioning, necessitating continued fluid support.

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Area of Science:

  • Oncology
  • Pharmacology
  • Nephrology

Background:

  • Bone marrow transplantation (BMT) involves intensive chemotherapy and radiation, potentially leading to metabolic complications.
  • Urate metabolism is a key concern during BMT due to the risk of tumor lysis syndrome (TLS).
  • Allopurinol is commonly used for TLS prophylaxis, but its necessity without allopurinol warrants investigation.

Purpose of the Study:

  • To investigate urate metabolism and excretion patterns in patients undergoing BMT without allopurinol.
  • To assess the safety and efficacy of BMT without allopurinol in patients with low tumor burden.
  • To evaluate the reliability of serum uric acid levels as an indicator of urate production during BMT.

Main Methods:

  • Studied 36 patients undergoing allogeneic and autologous BMT without allopurinol.
  • Utilized three preparative regimens: busulfan/cyclophosphamide (BUCY), BEAM (BCNU, etoposide, ara-C, melphalan), and cyclophosphamide/total body irradiation (CY/TBI).
  • Monitored urate excretion, urinary urate concentrations, and serum uric acid levels throughout the conditioning and post-transplant periods.

Main Results:

  • Urate excretion increased during all regimens, with varying patterns.
  • Elevated urate excretion persisted for 72 hours post-BEAM and BUCY regimens.
  • Urinary urate concentrations remained stable, indicating adequate hydration; no TLS or significant creatinine rise occurred.
  • Serum uric acid levels were poor indicators of urate production.

Conclusions:

  • BMT can be safely conducted without allopurinol in low tumor burden patients with adequate hydration.
  • Sustained elevated urate excretion post-conditioning necessitates continued hydration for at least 72 hours.
  • Serum uric acid is an unreliable marker for monitoring urate metabolism during BMT.

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