Rasburicase Real-World Usage for the Prevention and Treatment of Tumor Lysis Syndrome in Adults and Children

Rasburicase is used to prevent and treat tumor lysis syndrome (TLS) by breaking down uric acid. Administration methods vary, including fixed, weight-based (0.15-0.2 mg/kg), single and multiple doses. Our primary objective is to describe rasburicase use in both adults and children for TLS prevention and treatment. Secondary objectives are to describe the efficacy and safety of different regimens inventoried. Exploratory objective is to estimate savings associated with use of a single fixed dose.

Retrospective descriptive study conducted among patients who received rasburicase for TLS prevention or treatment between January 2014 and April 2024 in 3 oncology services of the Hospital Center.

A total of 133 adults and 60 children were included, of which 42.9% and 5.0%, respectively, presented biochemical TLS pre-rasburicase. A single 6 mg dose was administered in 86.5% of adults and 21.7% of children. Multiple daily doses were used in 24.8% of adults and 76.7% of children. Few adults (1.5%) received weight-based doses, contrary to children (76.7%). Normalized uric acid (< 476 μmol/L) was observed in 97.9% of patients 24 hours after a first dose, with no serious adverse events. Estimated savings were 86 542.92 CA$ if all patients included (n = 193) received a single 0.15 mg/kg dose, capped at 6 mg.

In the adult and pediatric population, a single rasburicase dose of 0.15 to 0.2 mg/kg, capped at 6 mg, represents an effective, safe, and more cost-effective option for both the prevention and treatment of TLS. Further studies are warranted to compare single versus multiple dosing in pediatric populations and to identify potential risk factors for nonresponders.