Table 2.
Results of studies of low dose rasburicase
| Study (design) | No. of patients | Malignancy | Rasburicase regimen | Results |
|---|---|---|---|---|
| J Coutsouvelis8 (Prospective study-2013) |
41 (adults) | Aggressive Lymphomas, AML, ALL | 3 mg/day | 20 pts with normal uric acid levels required only single dose to prevent TLS, out of 19 pts with elevated uric acid, single dose was effective in 14 cases |
| Trifilio5 (Retrospective chart review 2010) |
247 (adults) | Plasma cell neoplasm, NHL, AML, CLL, MDS | 3 mg × 1 | a single 3-mg dose of rasburicase, used with close monitoring, is sufficient to treat most adults with uric acid levels up to 12 mg/dl |
| Vines15 (Retrospective chart review 2010) |
34 (adults) | AML, ALL, NHL, MM, HD, solid tumor | 6 mg × 1 | UA normalized to less than 4 mg/dL by day 3, 2 pts required repeat dose |
| McBride13 (Retrospective chart review 2013) | 373 (adults) | Hematologic (AML, lymphoma, MM) or solid tumor | 3 mg × 1 (n = 38) 6 mg × 1 (n = 99) 7.5 mg × 1 (n = 43) Wt-based (median 0.16 mg/kg) × 1 (n = 193) |
UA reported on 319 patients—UA normalized in 313 patients within 24 h. No statistical significant difference across doses. Study concluded that 6 mg may be most appropriate single dose |
| Herrington7 (Retrospective chart review 2015) | 45 patients (adult) | Acute and chronic leukemia, NHL, HD, MM, other | 1.5 mg (n = 6) 3 mg (n = 26) 4.5 mg (n = 1) 6 mg (n = 12) | UA normalized to less than 8 mg/dL in 80% of patients. Five patients required repeat dose. Greater reduction in UA seen with higher doses of rasburicase |
| Vadhan-Raj14 (Prospective study-RCT 2012) |
82 (adults) | Acute leukemia, aggressive lymphomas | 0.15 mg/kg single dose versus 5 daily dose | 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) |
| Latha10 (Retrospective chart review 2015) |
7 (pediatric) | Acute lymphoblastic leukemia | Single dose 0.15 mg/kg | All patients responded to a single dose |
| Jayabose16 (Retrospective chart review 2015) |
41 pediatric | Acute leukemia, NHL | Single dose 0.15 mg/kg | Twenty-seven needed only one dose; 12 needed 2 or 3 doses; and two needed 5 doses each. One child required dialysis |
| Kukkar17 (Retrospective chart review 2016) |
15 (10 pediatrics and 5 adults) | hematologic malignancies at risk for TLS | Single dose 0.15 mg/kg | single dose of rasburicase produced a rapid and sustained therapeutic effect of lowering the plasma UA levels in all the 15 patients |
| Antony R11 (Retrospective chart review 2015) |
55 patients (adult) |
High risk haematological and solid tumors | Single 1.5 mg dose | 52 patients UA levels reduced with 24 h, by day 3 all patients UA levels reduced |
Pts patients, NHL Non hodgkins lymphoma, AML acute myeloid leukemia, ALL acute lymphoblastic leukemia, CLL chronic lymphoblastic leukemia, TLS tumor lysis syndrome, MM multiple myeloma, UA Uric Acid