Follow-Up Study on Management of Tumour Lysis Syndrome with Single Low Fixed Dose (1.5 mg) of Rasburicase - A Tertiary Cancer Centre Experience from India


Alok Ranjan1, Nisha Khanna2, Vivek Ranjan3, Ashwin Kumar4

Rasburicase (recombinant urate oxidase) has been proven to be an effective
therapy for prevention of tumour lysis syndrome (TLS). The recommended daily
dosing regimen of rasburicase is 0.2 mg/kg/day for 5 days which is expensive and
unaffordable to many patients in the developing countries. The purpose of the
present study was to evaluate the effect of single 1.5 mg dose rasburicase in the
management of tumour lysis syndrome.
This is a follow-up study done at our institute. Fifty (50) patients with tumour lysis
syndrome who received rasburicase from August 2015 to January 2020 were
enrolled in this study.
Single dose of rasburicase is effective in decreasing serum uric acid level in
significant number (N = 41) of patients. Percentage of patients having uric acid
less than 7 mg after single dose of rasburicase in 48 hours - 82.9 % (N = 34)
while 17 % (N = 7) were found to have uric acid levels of more than 7 mg/dl. The
percentage of patients with uric acid levels more than 7 mg/dl reduced from 36.5
% after 24 hours to 17 % after 48 hours. This indicates that the uric acid levels
show a declining trend even after 24 hours without giving an additional dose of
rasburicase. There was no relationship between uric acid levels at 24 hours and
percentage change in creatinine level from baseline to 24 hours (correlation
coefficient (r) = -0.047, P = 0.770. Patients who required additional dose (N = 9)
had high base line value of uric acid and their high value was maintained over the
follow up period of three days. Patients with pre exiting kidney disease and high
level of baseline uric acid also needed dialysis (N = 3).
In majority of patients, a single 1.5 mg dose of rasburicase is an effective way to
reduce raised uric acid in appropriate circumstances.