Oncology: Fixed-Dose Rasburicase 6 mg for Hyperuricemia and Tumor Lysis Syndrome in High-Risk Cancer Patients

2010 ◽  
Vol 44 (10) ◽  
pp. 1529-1537 ◽  
Author(s):  
Ashleigh N Vines ◽  
Carl B Shanholtz ◽  
Jennifer L Thompson
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Tumor Lysis Syndrome ◽  
Fixed Dose ◽  
Tumor Lysis ◽  
High Risk Cancer

Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome: An Evidence-Based Review

2008 ◽  
Vol 26 (16) ◽  
pp. 2767-2778 ◽  
Author(s):  
Bertrand Coiffier ◽  
Arnold Altman ◽  
Ching-Hon Pui ◽  
Anas Younes ◽  
Mitchell S. Cairo
Keyword(s):  
At Risk ◽  
High Risk ◽  
Tumor Lysis Syndrome ◽  
The United States ◽  
Standards Of Care ◽  
Close Monitoring ◽  
Tumor Lysis ◽  
High Risk Patients ◽  
Patients At Risk ◽  
Risk Patients

PurposeTumor lysis syndrome (TLS) has recently been subclassified into either laboratory TLS or clinical TLS, and a grading system has been established. Standardized guidelines, however, are needed to aid in the stratification of patients according to risk and to establish prophylaxis and treatment recommendations for patients at risk or with established TLS.MethodsA panel of experts in pediatric and adult hematologic malignancies and TLS was assembled to develop recommendations and guidelines for TLS based on clinical evidence and standards of care. A review of relevant literature was also used.ResultsNew guidelines are presented regarding the prevention and management of patients at risk of developing TLS. The best management of TLS is prevention. Prevention strategies include hydration and prophylactic rasburicase in high-risk patients, hydration plus allopurinol or rasburicase for intermediate-risk patients, and close monitoring for low-risk patients. Primary management of established TLS involves similar recommendations, with the addition of aggressive hydration and diuresis, plus allopurinol or rasburicase for hyperuricemia. Alkalinization is not recommended. Although guidelines for rasburicase use in adults are provided, this agent is currently only approved for use in pediatric patients in the United States.ConclusionThe potential severity of complications resulting from TLS requires measures for prevention in high-risk patients and prompts treatment in the event that symptoms arise. Recognition of risk factors, monitoring of at-risk patients, and appropriate interventions are the key to preventing or managing TLS. These guidelines should assist in the prevention of TLS and improve the management of patients with established TLS.

scholarly journals Prevention and Treatment of Tumor Lysis Syndrome in the Era of Onco-Nephrology Progress

2020 ◽  
Vol 45 (5) ◽  
pp. 645-660
Author(s):  
Joanna Matuszkiewicz-Rowinska ◽  
Jolanta Malyszko
Keyword(s):  
High Risk ◽  
Treatment Plan ◽  
Diuretic Therapy ◽  
Tumor Lysis Syndrome ◽  
Phosphate Binders ◽  
Tumor Lysis ◽  
Threatening Condition ◽  
Clinical Consequences ◽  
Life Threatening ◽  
Knowledge Of Cancer

Background: Tumor lysis syndrome (TLS) is an oncologic emergency due to a rapid break down of malignant cells usually induced by cytotoxic therapy, with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and serious clinical consequences such as acute renal injury, cardiac arrhythmia, hypotension, and death. Rapidly expanding knowledge of cancer immune evasion mechanisms and host-tumor interactions has significantly changed our therapeutic strategies in hemato-oncology what resulted in the expanding spectrum of neoplasms with a risk of TLS. Summary: Since clinical TLS is a life-threatening condition, identifying patients with risk factors for TLS development and implementation of adequate preventive measures remains the most critical component of its medical management. In general, these consist of vigilant laboratory and clinical monitoring, vigorous IV hydration, urate-lowering therapy, avoidance of exogenous potassium, use of phosphate binders, and – in high-risk cases – considering cytoreduction before the start of the aggressive agent or a gradual escalation of its dose. Key Messages: In patients with a high risk of TLS, cytotoxic chemotherapy should be given in the facility with ready access to dialysis and a treatment plan discussed with the nephrology team. In the case of hyperkalemia, severe hyperphosphatemia or acidosis, and fluid overload unresponsive to diuretic therapy, the early renal replacement therapy (RRT) should be considered. One must remember that in TLS, the threshold for RRT initiation may be lower than in other clinical situations since the process of cell breakdown is ongoing, and rapid increases in serum electrolytes cannot be predicted.

Tumor lysis syndrome: an uncommon complication of fludarabine therapy of chronic lymphocytic leukemia.

1998 ◽  
Vol 16 (7) ◽  
pp. 2313-2320 ◽  
Author(s):  
B D Cheson ◽  
J N Frame ◽  
D Vena ◽  
N Quashu ◽  
J M Sorensen
Keyword(s):  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Disease Duration ◽  
Tumor Lysis Syndrome ◽  
Laboratory Data ◽  
Lymphocytic Leukemia ◽  
Phase Ii Trials ◽  
Tumor Lysis ◽  
Laboratory Features

PURPOSE To quantify the incidence and severity of tumor lysis syndrome (TLS) as a consequence of fludarabine therapy in patients with advanced chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS A retrospective review and questionnaire follow-up of clinical and laboratory data were performed on patients with intermediate or high-risk CLL on the National Cancer Institute Group C protocol or special exception mechanisms, or phase II trials of fludarabine, for whom adverse drug reports of TLS were available. Fludarabine was administered at a dose of 20 to 40 mg/m2 per day for 5 days at monthly intervals. RESULTS Among the 6,137 patients, TLS was suspected in 26 (0.42%), with clinical and laboratory features consistent with TLS present in 20 (0.33%). Prophylaxis against TLS had been administered to 60% of these patients. Clinical or laboratory features were similar to patients who did not develop TLS. Of the patients with TLS, 90% had high-risk CLL, 60 months of prior disease duration, with a median pretreatment WBC of 109 x 10(9)/L, two prior regimens, lymphadenopathy in 89%, splenomegaly and/or hepatomegaly in 90%. TLS developed on approximately day 7 and lasted a median of 9.5 days. Dialysis was required in 30% during the TLS episode; 20% of patients died during cycle one of fludarabine therapy with renal failure, and another 20% died of infection or congestive heart failure. Six patients were retreated with fludarabine without recurrent TLS. CONCLUSION TLS after fludarabine therapy is extremely uncommon, but may be associated with significant morbidity and mortality.

Immune Biomarkers of BRONJ in High-Risk Cancer Patients

2012 ◽  
Vol 70 (9) ◽  
pp. e37
Author(s):  
A. Leung ◽  
P. Lee ◽  
A. Kiss ◽  
S. Choyee ◽  
J. Uyanne ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Immune Biomarkers ◽  
High Risk Cancer

scholarly journals Study of germline mutations in high risk cancer patients from a tertiary care center in India

2019 ◽  
Vol 30 ◽  
pp. ix127-ix128
Author(s):  
P.S. Kulkarni ◽  
S.S. Gandhi ◽  
A.M. Dastane ◽  
C.D. Deshmukh ◽  
S. Hingmire ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Germline Mutations ◽  
Tertiary Care Center ◽  
High Risk Cancer

scholarly journals Epidemiology of Bloodstream Infections at a Cancer Center

2000 ◽  
Vol 118 (5) ◽  
pp. 131-138 ◽  
Author(s):  
Eduardo Velasco ◽  
Luiz Claudio Santos Thuler ◽  
Carlos Alberto de Souza Martins ◽  
Márcio Nucci ◽  
Leda Maria Castro Dias ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Care Center ◽  
Bloodstream Infections ◽  
Infectious Complications ◽  
Cancer Center ◽  
Coagulase Negative Staphylococcus ◽  
Oxacillin Resistance ◽  
High Risk Cancer ◽  
Epidemiological Characteristics

CONTEXT: Cancer patients are at unusually high risk for developing bloodstream infections (BSI), which are a major cause of in-hospital morbidity and mortality. OBJECTIVE: To describe the epidemiological characteristics and the etiology of BSI in cancer patients. DESIGN: Descriptive study. SETTING: Terciary Oncology Care Center. PARTICIPANTS: During a 24-month period all hospitalized patients with clinically significant BSI were evaluated in relation to several clinical and demographic factors. RESULTS: The study enrolled 435 episodes of BSI (349 patients). The majority of the episodes occurred among non-neutropenic patients (58.6%) and in those younger than 40 years (58.2%). There was a higher occurrence of unimicrobial infections (74.9%), nosocomial episodes (68.3%) and of those of undetermined origin (52.8%). Central venous catheters (CVC) were present in 63.2% of the episodes. Overall, the commonest isolates from blood in patients with hematology diseases and solid tumors were staphylococci (32% and 34.7%, respectively). There were 70 episodes of fungemia with a predominance of Candida albicans organisms (50.6%). Fungi were identified in 52.5% of persistent BSI and in 91.4% of patients with CVC. Gram-negative bacilli prompted the CVC removal in 45.5% of the episodes. Oxacillin resistance was detected in 26.3% of Staphylococcus aureus isolates and in 61.8% of coagulase-negative Staphylococcus. Vancomycin-resistant enterococci were not observed. Initial empirical antimicrobial therapy was considered appropriate in 60.5% of the cases. CONCLUSION: The identification of the microbiology profile of BSI and the recognition of possible risk factors in high-risk cancer patients may help in planning and conducting more effective infection control and preventive measures, and may also allow further analytical studies for reducing severe infectious complications in such groups of patients.

Sign in / Sign up

Export Citation Format

Share Document