[Rasburicase versus allopurinol in the treatment of hyperuricaemia in tumour lysis syndrome]

Abstract

Introduction: Hyperuricaemia accompanying tumour lysis syndrome (TLS) is a serious complication in neoplasias with rapid proliferation and cellular destruction. The aim of the study was to evaluate the effects of rasburicase versus allopurinol on plasma uric acid, creatinine and phosphorus levels in paediatric patients with TLS.

Patients and method: A comparative study of treatment with rasburicase or allopurinol was performed in 32 paediatric patients with haematological-oncological malignancies and with established TLS or a high risk of developing it, admitted to the Paediatric Intensive Care Unit (PICU). Allopurinol (10mg/kg/day every 8h) was administered to 16 patients between January 1991 and January 2003, and 16 patients received rasburicase (0.2mg/kg/day, once daily), from February 2003 to June 2009. Plasma uric acid, creatinine and phosphorus levels were measured at baseline and 4, 12, 24, 36, 48, 72 and 96h after therapy in both study groups.

Results: Baseline uric acid levels were similar in both groups. Four hours after the first dose, patients treated with rasburicase achieved a greater reduction (p<0.0001) of initial plasma uric acid levels compared to allopurinol, as in the other serial determinations. Creatinine levels were higher in the allopurinol group than in the rasburicase one. Plasma phosphorus levels were similar in both groups. Haemodialysis was required in 56% of patients in the allopurinol group, whereas none of rasburicase group needed this.

Conclusion: This study demonstrated that there is more rapid control and lower plasma uric acid levels in patients at high risk for tumour lysis syndrome who received rasburicase compared to allopurinol, as well as lower levels of creatinine and a lower percentage of haemodialysis.