Contributions
Abstract: PB2391
Type: Publication Only
Background
Allopurinol, an inhibitor of xanthine oxidase, has long been considered the standard agent for the management of hyperuricemia in patients with preexisting hyperuricemia from spontaneous tumor lysis syndrome (TLS), or patients at high risk for developing TLS during chemotherapy (CT). Rasburicase is a recombinant urate oxidase enzyme which represent an effective alternative to allopurinol in rapidly reducing uric acid (UA) levels, improving patients electrolyte status, and reversing renal impairment, and the recommended dose is 0.2 mg/kg/day administered intravenously for up to five days, with a very high cost.
Aims
To evaluate and characterize a single weight-based dose of rasburicase followed by oral allopurinol for treatment of preexisting hyperuricemia related with TLS and in patients at high-risk for TLS, as well as to determine the effect on serum creatinine (Cr).
Methods
Retrospective medical record review, between February 2012 to August 2017, from patients with de novo or relapse/progressive hematological malignancies who received a single weight-based dose of rasburicase (0.2mg/kg, intravenously). Subsequent control of UA and Cr were recorded at baseline and monitored daily after initial rasburicase administration.
Results
A total of 32 administrations in 30 adult patients with de novo disease (19) and with relapse/progressive disease (13), and rasburicase was started the day before of CT protocol. Two patients received 2 administrations, but at different phases of the disease. At the time of administration 96.9% of the cases had hyperuricemia (>6.0 mg/dL), and 3.1% had a high-risk of TLS. The median baseline UA and Cr levels were 11.0 mg/dL (3.6-22.3) and 1.57 mg/dL (0.65-5.67), respectively. All patients responded to rasburicase presenting undetectable UA levels (<0.2-0.5 mg/dL) 24 hours after rasburicase administration, and detectable UA levels from the 5th day and at that time successfully started allopurinol 300mg daily. The 7th day median of UA and Cr levels in the available patients was 3.65 mg/dL (0.7-9.7) and 1.15 mg/dL (0.41-3.52), respectively. No patient needed additional dose of rasburicase, as no one required renal replacement therapy TLS related, during CT. The use of rasburicase in single weight-based dose led to a saving of € 72891,88 compared to 5 days of administration.
Conclusion
According to our results, the use of a single weight-based dose of rasburicase has demonstrated to be well tolerated, and seems to be an effective and inexpensive therapeutic strategy in managing hyperuricemia secondary to TLS, which should be considered in an era of high health costs due to innovatory therapies directed at molecular targets.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Cost analysis, Hematological malignancy, Rasburicase, Tumor lysis
Abstract: PB2391
Type: Publication Only
Background
Allopurinol, an inhibitor of xanthine oxidase, has long been considered the standard agent for the management of hyperuricemia in patients with preexisting hyperuricemia from spontaneous tumor lysis syndrome (TLS), or patients at high risk for developing TLS during chemotherapy (CT). Rasburicase is a recombinant urate oxidase enzyme which represent an effective alternative to allopurinol in rapidly reducing uric acid (UA) levels, improving patients electrolyte status, and reversing renal impairment, and the recommended dose is 0.2 mg/kg/day administered intravenously for up to five days, with a very high cost.
Aims
To evaluate and characterize a single weight-based dose of rasburicase followed by oral allopurinol for treatment of preexisting hyperuricemia related with TLS and in patients at high-risk for TLS, as well as to determine the effect on serum creatinine (Cr).
Methods
Retrospective medical record review, between February 2012 to August 2017, from patients with de novo or relapse/progressive hematological malignancies who received a single weight-based dose of rasburicase (0.2mg/kg, intravenously). Subsequent control of UA and Cr were recorded at baseline and monitored daily after initial rasburicase administration.
Results
A total of 32 administrations in 30 adult patients with de novo disease (19) and with relapse/progressive disease (13), and rasburicase was started the day before of CT protocol. Two patients received 2 administrations, but at different phases of the disease. At the time of administration 96.9% of the cases had hyperuricemia (>6.0 mg/dL), and 3.1% had a high-risk of TLS. The median baseline UA and Cr levels were 11.0 mg/dL (3.6-22.3) and 1.57 mg/dL (0.65-5.67), respectively. All patients responded to rasburicase presenting undetectable UA levels (<0.2-0.5 mg/dL) 24 hours after rasburicase administration, and detectable UA levels from the 5th day and at that time successfully started allopurinol 300mg daily. The 7th day median of UA and Cr levels in the available patients was 3.65 mg/dL (0.7-9.7) and 1.15 mg/dL (0.41-3.52), respectively. No patient needed additional dose of rasburicase, as no one required renal replacement therapy TLS related, during CT. The use of rasburicase in single weight-based dose led to a saving of € 72891,88 compared to 5 days of administration.
Conclusion
According to our results, the use of a single weight-based dose of rasburicase has demonstrated to be well tolerated, and seems to be an effective and inexpensive therapeutic strategy in managing hyperuricemia secondary to TLS, which should be considered in an era of high health costs due to innovatory therapies directed at molecular targets.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Cost analysis, Hematological malignancy, Rasburicase, Tumor lysis