Abstract
Hyperleukocytosis [white blood cell count (WBC) >100×109/l] occurs in 5%–22% of pediatric patients with acute leukemia. Rasburicase (recombinant urate oxidase) is very effective for the prophylaxis and treatment of hyperuricemia, but its efficacy in marked hyperleukocytosis (WBC >200×109/l) is not well known. We describe three children with marked hyperleukocytosis (WBC of 508, 320, and 242×109/l) at initiation of induction chemotherapy. All three received rasburicase. Minimal metabolic disturbance occurred in all patients. We conclude that WBC reduction strategies may not be required solely for the risk of tumor lysis syndrome in patients with very high WBC (>200×109/l) who are treated with rasburicase.
References
Thiébaut A, Thomas X, Belhabri A, Anglaret B, Archimbaud E (2000) Impact of preinduction therapy leukapheresis on treatment outcome in adult acute myelogenous leukemia presenting with hyperleukocytosis. Ann Hematol 79:501–506
Bunin NJ, Pui CH (1985) Differing complications of hyperleukocytosis in children with acute lymphoblastic or acute nonlymphoblastic leukemia. J Clin Oncol 3:1590–1595
Del Vasto F, Caldore M, Russo F, Bertuccioli A, Pellegrini F (1982) Exchange transfusion in leukemia with hyperleukocytosis. J Pediatr 100:1000
Maurer HS, Steinherz PG, Gaynon PS, Finklestein JZ, Sather HN, Reaman GH, Bleyer WA, Hammond GD (1988) The effect of initial management of hyperleukocytosis on early complications and outcome of children with acute lymphoblastic leukemia. J Clin Oncol 6:1425–1432
Eguiguren JM, Schell MJ, Crist WM, Kunkel K, Rivera GK (1992) Complications and outcome in childhood acute lymphoblastic leukemia with hyperleukocytosis. Blood 79:871–875
Bunin NJ, Kunkel K, Callihan TR (1987) Cytoreductive procedures in the early management in cases of leukemia and hyperleukocytosis in children. Med Pediatr Oncol 15:232–235
Patte C, Sakiroglu O, Sommelet D (2001) European experience in the treatment of hyperuricemia. Semin Hematol 38 [Suppl] 10:9–12
Pui CH, Mahmoud HH, Wiley JM, Woods GM, Leverger G, Camitta B, Hastings C, Blaney SM, Relling MV, Reaman GH (2001) Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma. J Clin Oncol 19:697–704
Patte C, Sakiroglu C, Ansoborlo S, Baruchel A, Plouvier E, Pacquement H, Babin-Boilletot A (2002) Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia, treated in the Société Française d’Oncologie Pédiatrique LMB89 protocol. Ann Oncol 13:789–795
Goldman SC, Holcenberg JS, Finklestein JZ, Hutchinson R, Kreissman S, Johnson FL, Tou C, Harvey E, Morris E, Cairo MS (2001) A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumour lysis. Blood 97:2998–3003
Leach M, Parsons RM, Reilly JT, Winfield DA (1998) Efficacy of urate oxidase (uricozyme) in tumour lysis induced urate nephropathy. Clin Lab Haematol 20:169–172
Jankovic M, Zurlo MG, Rossi E, Edefonti A, Cossu MM, Giani M, Masera G (1985) Urate-oxidase as hypouricemic agent in a case of acute tumour lysis syndrome. Am J Pediatr Hematol Oncol 7:202–204
Crews KR, Wimmer PS, Hudson JQ, Howard SC, Ribeiro RC, Razzouk BI (2002) Pharmacokinetics of 2-chlorodeoxyadenosine in a child undergoing hemofiltration and hemodialysis for acute renal failure. J Pediatr Hematol Oncol 24:677–680
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Macfarlane, R.J., McCully, B.J. & Fernandez, C.V. Rasburicase prevents tumor lysis syndrome despite extreme hyperleukocytosis. Pediatr Nephrol 19, 924–927 (2004). https://doi.org/10.1007/s00467-004-1524-y
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DOI: https://doi.org/10.1007/s00467-004-1524-y