2017 年 41 巻 2 号 p. 183-190
Tumor lysis syndrome (TLS) is a life-threatening complication caused by the massive death of cancer cells upon chemotherapy. Lowering serum uric acid (S-UA) levels is crucial to controlling TLS. Febuxostat was approved for use in treating chemotherapy-associated hyperuricemia in May 2016. Rasburicase and febuxostat are now the major UA-reducing agents; the former for high risk, the latter for intermediate risk. The present study retrospectively evaluated the efficacy of rasburicase in cancer patients in our institution after the approval of febuxostat of this use (June 2016 - January 2017). The primary endpoint was the normalization of S-UA at the end of rasburicase administration. Rasburicase was used in 12 patients with hematological malignancies in the designated period. Eight patients were at high risk of TLS, while 2 patients had already developed TLS. The median dose administered was 0.2 mg/kg, and the median duration was 5 days. The S-UA at the baseline (10.4±3.0 mg/dL, mean±SD) was decreased below the normal levels in all patients (0.3±0.2 mg/dL) (P<0.0001, by paired t test). Serum creatinine levels also decreased from 1.2±0.4 to 0.8±0.2 mg/dL (P=0.0001, by paired t test), suggesting that controlling UA might potentially improve the renal function. Not all patients demonstrated a concomitant reduction in lactate dehydrogenase levels, which suggested that S-UA was successfully controlled by rasburicase despite the residual amount of cancer cells. Thus, rasburicase was successfully used for appropriate patients after the febuxostat era.
