Jeon Young-Woo, Kwak Dae-Hun, Park Sung-Soo, Yoon Jae-Ho, Lee Sung-Eun, Eom Ki-Seong, Kim Yoo-Jin, Kim Hee-Je, Lee Seok, Min Chang-Ki, Lee Jong-Wook, Min Woo-Sung, Cho Seok-Goo
Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; Institute for Translational Research and Molecular Imaging, Catholic Institutes of Medical Science, The Catholic University of Korea, Seoul, Korea; Laboratory of Immune Regulation, Convergent Research Consortium for Immunologic Disease, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Lymphoma Myeloma Leuk. 2017 Sep;17(9):595-603. doi: 10.1016/j.clml.2017.06.027. Epub 2017 Jun 27.
Tumor lysis syndrome (TLS) is a life-threatening disorder that occurs mainly in patients with high-tumor burden hemato-oncologic malignancies. It results in metabolic derangements, including hyperuricemia and acute renal failure. The powerful management for TLS is a daily dose of rasburicase for up to 5 days before chemotherapy; however, the optimal dose and duration of rasburicase for TLS prophylaxis have not been standardized for patients at high risk for TLS. Therefore, we evaluated the efficacy of single-dose rasburicase for prophylactic purposes in patients with malignant lymphoma at high risk for TLS.
We retrospectively evaluated patients with malignant lymphoma at high risk for TLS treated with a prophylactic single-dose of rasburicase (0.1-0.2 mg/kg) from March 2012 to March 2016.
A total of 67 patients treated with a single-dose of rasburicase for prophylaxis were analyzed. A relatively large number of patients (n = 23; 34.3%) had the highly proliferative lymphoblastic lymphoma subtype (n = 14) or Burkitt lymphoma (n = 9) and were at the highest risks of tumor lysis. Two patients were newly diagnosed with TLS; the incidence of TLS after single-dose prophylaxis was 3.0%. Multivariate analysis revealed no predictable risk factors for response to prophylactic rasburicase, though increased level of serum creatinine approached statistical significance in reducing the efficacy of single-dose rasburicase to prevent TLS (odds ratio, 3.61; P = .054).
Our data indicated that single-dose rasburicase effectively prevented progression of TLS, and, regardless of any risk factors, including increased creatinine, single-dose rasburicase for TLS prophylaxis was useful in patients with lymphoma at a high risk for TLS.
肿瘤溶解综合征（TLS）是一种危及生命的疾病，主要发生于高肿瘤负荷的血液肿瘤患者。它会导致代谢紊乱，包括高尿酸血症和急性肾衰竭。TLS的有效治疗方法是在化疗前连续5天每日使用拉布立酶；然而，对于TLS高危患者，拉布立酶预防TLS的最佳剂量和疗程尚未标准化。因此，我们评估了单剂量拉布立酶对TLS高危恶性淋巴瘤患者的预防效果。
我们回顾性评估了2012年3月至2016年3月接受单剂量拉布立酶（0.1 - 0.2 mg/kg）预防性治疗的TLS高危恶性淋巴瘤患者。
共分析了67例接受单剂量拉布立酶预防性治疗的患者。相当一部分患者（n = 23；34.3%）患有高增殖性淋巴细胞淋巴瘤亚型（n = 14）或伯基特淋巴瘤（n = 9），处于肿瘤溶解的最高风险。2例患者新诊断为TLS；单剂量预防后TLS的发生率为3.0%。多因素分析显示，对于预防性拉布立酶的反应，没有可预测的风险因素，尽管血清肌酐水平升高在降低单剂量拉布立酶预防TLS的疗效方面接近统计学意义（比值比，3.61；P = 0.054）。
我们的数据表明，单剂量拉布立酶有效地预防了TLS的进展，并且，无论任何风险因素，包括肌酐升高，单剂量拉布立酶预防TLS对TLS高危淋巴瘤患者是有用的。
