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A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis.

Publication ,  Journal Article
Goldman, SC; Holcenberg, JS; Finklestein, JZ; Hutchinson, R; Kreissman, S; Johnson, FL; Tou, C; Harvey, E; Morris, E; Cairo, MS
Published in: Blood
May 15, 2001

Standard therapy in the United States for malignancy-associated hyperuricemia consists of hydration, alkalinization, and allopurinol. Urate oxidase catalyzes the enzymatic oxidation of uric acid to a 5 times increased urine soluble product, allantoin. Rasburicase is a new recombinant form of urate oxidase available for clinical evaluation. This multicenter randomized trial compared allopurinol to rasburicase in pediatric patients with leukemia or lymphoma at high risk for tumor lysis. Patients received the assigned uric acid-lowering agent for 5 to 7 days during induction chemotherapy. The primary efficacy end point was to compare the area under the serial plasma uric acid concentration curves during the first 96 hours of therapy (AUC(0-96)). Fifty-two patients were randomized at 6 sites. In an intent-to-treat analysis, the mean uric acid AUC(0-96) was 128 +/- 70 mg/dL.hour for the rasburicase group and 329 +/- 129 mg/dL.hour for the allopurinol group (P <.0001). The rasburicase versus allopurinol group experienced a 2.6-fold (95% CI: 2.0-3.4) less exposure to uric acid. Four hours after the first dose, patients randomized to rasburicase compared to allopurinol achieved an 86% versus 12% reduction (P <.0001) of initial plasma uric acid levels. No antirasburicase antibodies were detected at day 14. This randomized study demonstrated more rapid control and lower levels of plasma uric acid in patients at high risk for tumor lysis who received rasburicase compared to allopurinol. For pediatric patients with advanced stage lymphoma or high tumor burden leukemia, rasburicase is a safe and effective alternative to allopurinol during initial chemotherapy.

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Published In

Blood

DOI

ISSN

0006-4971

Publication Date

May 15, 2001

Volume

97

Issue

10

Start / End Page

2998 / 3003

Location

United States

Related Subject Headings

  • Uric Acid
  • Urate Oxidase
  • Tumor Lysis Syndrome
  • Treatment Outcome
  • Risk Factors
  • Renal Insufficiency
  • Recombinant Proteins
  • Male
  • Lymphoma
  • Leukemia
 

Citation

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Goldman, S. C., Holcenberg, J. S., Finklestein, J. Z., Hutchinson, R., Kreissman, S., Johnson, F. L., … Cairo, M. S. (2001). A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. Blood, 97(10), 2998–3003. https://doi.org/10.1182/blood.v97.10.2998
Goldman, S. C., J. S. Holcenberg, J. Z. Finklestein, R. Hutchinson, S. Kreissman, F. L. Johnson, C. Tou, E. Harvey, E. Morris, and M. S. Cairo. “A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis.Blood 97, no. 10 (May 15, 2001): 2998–3003. https://doi.org/10.1182/blood.v97.10.2998.
Goldman SC, Holcenberg JS, Finklestein JZ, Hutchinson R, Kreissman S, Johnson FL, et al. A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. Blood. 2001 May 15;97(10):2998–3003.
Goldman, S. C., et al. “A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis.Blood, vol. 97, no. 10, May 2001, pp. 2998–3003. Pubmed, doi:10.1182/blood.v97.10.2998.
Goldman SC, Holcenberg JS, Finklestein JZ, Hutchinson R, Kreissman S, Johnson FL, Tou C, Harvey E, Morris E, Cairo MS. A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. Blood. 2001 May 15;97(10):2998–3003.

Published In

Blood

DOI

ISSN

0006-4971

Publication Date

May 15, 2001

Volume

97

Issue

10

Start / End Page

2998 / 3003

Location

United States

Related Subject Headings

  • Uric Acid
  • Urate Oxidase
  • Tumor Lysis Syndrome
  • Treatment Outcome
  • Risk Factors
  • Renal Insufficiency
  • Recombinant Proteins
  • Male
  • Lymphoma
  • Leukemia