Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, MD, USA.
Ann Oncol. 2012 Jun;23(6):1640-5. doi: 10.1093/annonc/mdr490. Epub 2011 Oct 19.
Tumor lysis syndrome (TLS) is a life-threatening disorder characterized by hyperuricemia and metabolic derangements. The efficacy of rasburicase, administered daily for 5 days, has been well established. However, the optimal duration of therapy is unknown in adults.
We evaluated the efficacy of rasburicase (0.15 mg/kg) administered as single dose followed by as needed dosing (maximum five doses) versus daily dosing for 5 days in adult patients at risk for TLS.
Eighty of the 82 patients enrolled received rasburicase; 40 high risk [median uric acid (UA) 8.5 mg/dl; range, 1.5-19.7] and 40 potential risk (UA = 5.6 mg/dl; range, 2.4-7.4). Seventy-nine patients (99%) experienced normalization in their UA within 4 h after the first dose; 84% to an undetectable level (<0.7 mg/dl). Thirty-nine of 40 (98%) patients in the daily-dose arm and 34 of 40 (85%) patients in single-dose arm showed sustained UA response. Six high-risk patients within the single-dose arm required second dose for UA >7.5 mg/dl. Rasburicase was well tolerated; one patient with glucose-6-phosphate dehydrogenase deficiency developed methemoglobinemia and hemolysis.
Rasburicase is highly effective for prevention and management of hyperuricemia in adults at risk for TLS. Single-dose rasburicase was effective in most patients; only a subset of high-risk patients required a second dose.
肿瘤溶解综合征（TLS）是一种危及生命的疾病，其特征是血尿酸升高和代谢紊乱。已证实每天给予拉布立酶 5 天的疗效。然而，成人治疗的最佳持续时间尚不清楚。
我们评估了在 TLS 高危成人患者中，拉布立酶（0.15mg/kg）单剂量给药后按需（最大 5 个剂量）与连续 5 天每日剂量给药的疗效。
82 例入组患者中有 80 例接受了拉布立酶治疗；40 例为高危（中位数尿酸（UA）8.5mg/dl；范围，1.5-19.7），40 例为潜在风险（UA=5.6mg/dl；范围，2.4-7.4）。79 例患者（99%）在首次给药后 4 小时内 UA 恢复正常；84%降至不可检测水平（<0.7mg/dl）。连续剂量组的 40 例患者中有 39 例（98%）和单剂量组的 40 例患者中有 34 例（85%）的 UA 持续反应。单剂量组中有 6 例高危患者 UA ＞7.5mg/dl 需用第二剂。拉布立酶耐受性良好；1 例葡萄糖-6-磷酸脱氢酶缺乏症患者出现高铁血红蛋白血症和溶血。
拉布立酶对 TLS 高危成人的高尿酸血症预防和治疗非常有效。单剂量拉布立酶对大多数患者有效；只有少数高危患者需要第二剂。
