2023 Volume 60 Issue 2 Pages 143-148
Background: Tumor lysis syndrome (TLS) is a potentially fatal complication associated with the treatment of childhood leukemia. A practical guideline by the Japanese Society of Pediatric Hematology/Oncology in 2016 indicates the standard therapy for TLS; it does not recommend urinary alkalization as a premise for the use of rasburicase. However, the current situation regarding supportive care for patients with TLS has not been clarified in Japan. Therefore, we conducted a nationwide survey of the institutions participating in the Japanese Pediatric Leukemia/Lymphoma Study Group.
Method: From February to June 2016, we conducted a web survey of practitioners at 155 facilities using SurveyMonkey®.
Results: We received valid responses from 99 facilities (64%). Urinary alkalinization was performed at initiation of induction therapy in 54% of the institutions, and it was conducted in 67% of the facilities where five or fewer new hematopoietic tumors were reported per year. Uric acid production inhibitors were administered prophylactically in 75% of the facilities. Rasburicase was used in most institutions to treat TLS with an average continuous duration of 5.4 days. Regarding the re-administration of rasburicase, 45% of the respondents reported no adverse effects; however, data from the period between the initial administration and re-administration were not investigated.
Conclusions: This survey showed that rasburicase was widely used for the prevention and treatment of TLS, but that 54% of the institutions utilized urinary alkalinization. It is important that TLS is appropriately managed in all childhood cancer treatment facilities in the rasburicase era.
