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Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase

Authors Alakel N, Middeke JM, Schetelig J, Bornhäuser M

Received 29 August 2016

Accepted for publication 12 December 2016

Published 2 February 2017 Volume 2017:10 Pages 597—605

DOI https://doi.org/10.2147/OTT.S103864

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Jianmin Xu

Nael Alakel,1 Jan Moritz Middeke,1 Johannes Schetelig,1,2 Martin Bornhäuser1

1Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden, 2German Bone Marrow Donor Center DKMS, Tübigen, Germany

Abstract: Tumor lysis syndrome (TLS) is a potentially life-threatening condition that occurs in oncologic and hematologic patients with large tumor burden, either due to cytotoxic therapy or, less commonly, spontaneously because of massive tumor cell lysis. TLS is clinically characterized by acute renal failure, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. While limited options are available for treating TLS, identifying patients at high risk for developing TLS and prevention in high-risk patients remain an important aspect in the treatment of cancer patients. In general, treatment of TLS consists of intensive hydration, stimulation of diuresis, and, more specifically, in the use of allopurinol and rasburicase. Rasburicase, a recombinant urate oxidase, rapidly and effectively reduces hyperuricemia, which subsequently significantly decreases the risk of acute renal failure and other clinical manifestations of TLS. For this review, a comprehensive literature search using the term “tumor lysis syndrome” and/or “rasburicase” was performed considering articles listed in MEDLINE. Incidence, prevention, and therapy of TLS with a special focus on the role of rasburicase are discussed. We evaluated 120 relevant articles including 35 case reports, 32 clinical trials, and 14 meta-analyses.

Keywords: rasburicase, tumor lysis syndrome, hyperuricemia, acute kidney injury

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