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Low-dose rasburicase in hematologic malignancies
Somasundaram Jayabose1, Vignesh Kumar, Rajeswari Dhanabalan
1Division of Pediatric Hematology-Oncology, Meenakshi Mission Hospital & Research Centre, Lake Area, Melur Road, Madurai, Tamil Nadu, India, sjayabose@gmail.com.
Insights
Low-dose rasburicase effectively reduced plasma uric acid in South Indian children with hematologic malignancies and tumor lysis syndrome (TLS). This treatment demonstrated safety, potentially lowering the risk of renal failure in this pediatric population.
Area of Science:
- Pediatric Oncology
- Nephrology
- Pharmacology
Background:
- Hematologic malignancies are common in children.
- Tumor lysis syndrome (TLS) is a serious complication of chemotherapy.
- Effective management of TLS is crucial to prevent renal failure.
Purpose of the Study:
- To evaluate the efficacy and safety of low-dose rasburicase in Indian children with hematologic malignancies.
- To assess the impact of rasburicase on plasma uric acid levels and renal function.
- To determine the optimal dosing regimen for rasburicase in this population.
Main Methods:
- Retrospective analysis of 41 children with hematologic malignancies and TLS.
- Treatment with rasburicase at doses of 0.1-0.15 mg/kg, repeated as needed.
- Monitoring of plasma uric acid, creatinine, and phosphate levels.
Main Results:
- Rasburicase significantly reduced plasma uric acid by a median of 80% within 6 hours.
- Most children required only one dose; 12 needed 2-3 doses.
- No anaphylaxis, hemolysis, or deaths related to TLS were observed; one child required dialysis.
Conclusions:
- Low-dose rasburicase (0.1-0.15 mg/kg) is safe and effective in reducing plasma uric acid in Indian children with lymphoid malignancies.
- This regimen may significantly decrease the risk of renal failure associated with TLS.
- Rasburicase offers a valuable therapeutic option for managing TLS in pediatric hematologic malignancies.
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 PO4 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.
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