Reduced doses of rasburicase in prevention of acute tumor lysis syndrome in patient with diffuse large B-cell lyphoma - a case report

Abstract

Acute tumor lysis syndrome (ATLS) is a group of metabolic complications that can occur as a result of acute lysis of malignant cells after initiation of cytostatic treatment or spontaneously even before introducing chemotherapy. Usually it is observed in patients with hematologic malignancies or solid tumors with high proliferative index. Since ATLS might be life-threatening, it is necessary to identify risk factors of this complication and to introduce prompt prophylactic treatment. Previously, it consisted of hydration, allopurinol administration and urine alcalinization. At present the new possibility of intervention gives us rasburicase - a recombinant urate oxidase, which directly decreases uric acid level catalyzing its conversion to a soluble, easily excreteable metabolite allantoin. High costs of rasburicase treatment at doses recommended by the manufacturer (0.2 mg/kg for 5 days), may discourage from its everyday usage. Here we present the effective administration of lower doses of rasburicase in combination with allopurinol to prevent development of clinical tumor lysis syndrome (CTLS) in a patient with diffuse large B-cell lymphoma. Administration of a single dose of rasburicase (4.5 mg) reduced plasma uric acid level from 14.3 to 0.4 mg/dl which continued to be low during subsequent CHOP chemotherapy. Such a management allowed us to achieve anticipated clinical effect with costs reduction of 96%.