Follow-Up Study on Management of Tumour Lysis Syndrome with Single Low Fixed Dose (1.5 mg) of Rasburicase - A Tertiary Cancer Centre Experience from India

BACKGROUND Rasburicase (recombinant urate oxidase) has been proven to be an effective therapy for prevention of tumour lysis syndrome (TLS). The recommended daily dosing regimen of rasburicase is 0.2 mg/kg/day for 5 days which is expensive and unaffordable to many patients in the developing countries. The purpose of the present study was to evaluate the effect of single 1.5 mg dose rasburicase in the management of tumour lysis syndrome. METHODS This is a follow-up study done at our institute. Fifty (50) patients with tumour lysis syndrome who received rasburicase from August 2015 to January 2020 were enrolled in this study RESULTS Single dose of rasburicase is effective in decreasing serum uric acid level in significant number (N = 41) of patients. Percentage of patients having uric acid less than 7 mg after single dose of rasburicase in 48 hours - 82.9 % (N = 34) while 17 % (N = 7) were found to have uric acid levels of more than 7 mg/dl. The percentage of patients with uric acid levels more than 7 mg/dl reduced from 36.5 % after 24 hours to 17 % after 48 hours. This indicates that the uric acid levels show a declining trend even after 24 hours without giving an additional dose of rasburicase. There was no relationship between uric acid levels at 24 hours and percentage change in creatinine level from baseline to 24 hours (correlation coefficient (r) = -0.047, P = 0.770. Patients who required additional dose (N = 9) had high base line value of uric acid and their high value was maintained over the follow up period of three days. Patients with pre exiting kidney disease and high level of baseline uric acid also needed dialysis (N = 3). CONCLUSIONS In majority of patients, a single 1.5 mg dose of rasburicase is an effective way to reduce raised uric acid in appropriate circumstances. KEYWORDS Single Dose, Recombinant Urate Oxidase, Uric Acid, Leukemia, Tumour Lysis Syndrome, Rasburicase

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Fixed-dose Recombinant Urate Oxidase In The Treatment Of Paediatric Tumour Lysis Syndrome – A Regional Cancer Centre Experience

Pediatric Hematology Oncology Journal ◽

10.1016/j.phoj.2018.11.181 ◽

2018 ◽

Vol 3 (3) ◽

pp. S63

Author(s):

M. Jyothi ◽

M. Padma ◽

A.R. Arun Kumar ◽

T. Avinash ◽

G. Ramesh ◽

...

Keyword(s):

Tumour Lysis Syndrome ◽

Urate Oxidase ◽

Fixed Dose ◽

Tumour Lysis ◽

Cancer Centre ◽

Regional Cancer Centre

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The value of low, fixed, single dose rasburicase in the prevention and treatment of tumor lysis syndrome.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18558 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18558-e18558

Author(s):

Bharadwaj Ponnada ◽

Saadvik Raghuram ◽

Sanketh Kotne ◽

Pavithran Keechilat

Keyword(s):

Uric Acid ◽

Single Dose ◽

Low Dose ◽

Medical Center ◽

Day Treatment ◽

Tumor Lysis Syndrome ◽

Urate Oxidase ◽

Fixed Dose ◽

Tumor Lysis ◽

Prevention And Treatment

e18558 Background: Rasburicase is a recombinant urate oxidase drug approved by the US FDA for the management of hyperuricemia in Tumor Lysis Syndrome (TLS). Recommended dose of 0.2 mg/kg/day for 5 days is expensive and the benefit of extended schedule compared to a single fixed dose of 1.5 mg is not known. Methods: This is a retrospective cohort study done at a tertiary medical center including 165 (144 adult and 21 pediatrics) patients admitted between January 2013 and December 2018. We analyzed the efficacy of single low dose rasburicase 1.5 mg irrespective of bodyweight in adults and in children a dose of 0.15 mg/kg (maximum 1.5 mg) intravenously over 30 min for prevention and treatment of TLS and subsequent doses were given based on clinical and biochemical response. Plasma samples for uric acid were collected at baseline, 6–24 hrs, 48 hrs post-rasburicase, and daily during treatment. The primary outcome was achieving a uric acid level less than 7.0 mg/dl after a single dose of rasburicase in the groups. Secondary outcomes included need for repeat rasburicase doses, and a cost analysis. Results: Children accounted for 12.1% (n = 20) and adults 87.9% (n = 145). The median ages in pediatric and adult groups were 7.9 years and 54 years respectively. Rasburicase was used prophylactically in 35 (21.2%), for laboratory TLS in 105 (63.6%) and for clinical TLS in 25 (15.2%) patients. SDR prevented laboratory/clinical TLS in 89% of the prophylactic group and prevented clinical TLS in 72% of the laboratory TLS group. However, 92%(n=23) of the patients with clinical TLS required more than one dose rasburicase. The average total monthly cost of rasburicase was reduced by 96% ($2850 to $114) after adoption of the above protocol. Conclusions: Single low dose rasburicase is a highly economical and clinically effective way of managing patients with TLS and could serve as an alternative to the 5-day treatment. This dose, therefore, balances cost and efficacy of treatment.

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Fixed-Dose Recombinant Urate Oxidase in the Treatment of Paediatric Tumour Lysis Syndrome: A Regional Cancer Centre Experience

Asian Pacific Journal of Cancer Prevention ◽

10.31557/apjcp.2021.22.12.3897 ◽

2021 ◽

Vol 22 (12) ◽

pp. 3897-3901

Author(s):

Appaji L ◽

Jyothi Reddy ◽

Pooja Chebbi ◽

Nuthan Kumar ◽

Arun Kumar AR ◽

...

Keyword(s):

Tumour Lysis Syndrome ◽

Urate Oxidase ◽

Fixed Dose ◽

Tumour Lysis ◽

Cancer Centre ◽

Regional Cancer Centre

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Bacteriuria in a Population Sample of Women: 24-year Follow-up Study: Results from the Prospective Population-based Study of Women in Gothenburg, Sweden

Scandinavian Journal of Urology and Nephrology ◽

10.1080/003655998750015467 ◽

1998 ◽

Vol 32 (4) ◽

pp. 284-289 ◽

Cited By ~ 35

Author(s):

Calle Bengtsson, Ulla Bengtsson, Ce

Keyword(s):

Population Sample ◽

Population Based ◽

Population Based Study ◽

Follow Up Study ◽

Study Results

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Topical Ethanol Therapy for Human Papillomavirus in Atheroma

Acupuncture & Electro-Therapeutics Research ◽

10.3727/036012921x16264625521763 ◽

2021 ◽

Author(s):

Etsuo Murata ◽

Kazutaka Tokita ◽

Shigeyuki Tsurusaki ◽

Hidetaka Murata

Keyword(s):

Human Papillomavirus ◽

Side Effects ◽

Simple Procedure ◽

Ring Test ◽

Pathological Examination ◽

Open Drainage ◽

Hpv 16 ◽

Follow Up Study ◽

Study Results

We have developed ethanol therapy for infectious atheroma based on the experience of two cases in which ethanol was injected into the liver cyst and the cyst shrank. For 64 infectious atheromas, atheroma contents were excreted and the cyst wall was contacted with 76% ethanol gauze for 5 minutes. Postoperatively, the cyst was washed daily as an open drainage. All cases were cured 10 days postoperatively, and no side effects. Postoperative follow up study results in 36 cases showed no recurrence in an average of 5 years. Pathological examination revealed koilocytosis in 14 of 25 cases (56%), which is considered to be an in direct finding of viral infection. The changes in human papillomavirus (HPV 16) before and after ethanol therapy in 25 cases using the Bi Digital O Ring Test (BDORT) decreased significantly from 10 26 ng (BDORT units) preoperatively to 1.6 ng (BDORT units) postoperatively. In also 12 cases follow up study without microscopy HPV 16 same decreased from 1064ng to 1.2 ng (BDORT unit) using BDORT with atheroma photographs. In total, HPV 16 could be demonstrated in 37 of 64 cases (57.8%) using BDOR T. Temporal changes of HPV 16 used for BDORT in 7 cases after contact with ethanol were inactivated after 3 minutes 30 seconds. The involvement of HPV 16 is suggested as the cause of atheroma. It is speculated that ethanol inactivated HPV 16 of atheroma, which stopped the turnover of the squamous epithelium and prevented recurrence. Ethanol therapy for infectious atheroma is useful as an original new one stage surgery because it is a simple procedure and has no side effects or recurrence.

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