Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma

被引:226
作者
Pui, CH
Mahmoud, HH
Wiley, JM
Woods, GM
Leverger, G
Camitta, B
Hastings, C
Blaney, SM
Relling, MV
Reaman, GH
机构
[1] St Jude Childrens Res Hosp, Memphis, TN 38105 USA
[2] Univ Tennessee, Memphis, TN USA
[3] Midw Childrens Canc Ctr, Milwaukee, WI USA
[4] Univ N Carolina, Chapel Hill, NC USA
[5] Childrens Mercy Hosp, Kansas City, MO 64108 USA
[6] Hop Armand Trousseau, Paris, France
[7] Childrens Hosp, Med Ctr No Calif, Oakland, CA USA
[8] Baylor Coll Med, Texas Childrens Canc Ctr, Houston, TX USA
[9] Childrens Natl Med Ctr, Washington, DC 20010 USA
关键词
D O I
10.1200/JCO.2001.19.3.697
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To improve the central of hyperuricemia in patients with leukemia or lymphoma, we tested a newly developed uricolytic agent, recombinant urate oxidase (SR29142; Rasburicase; Sanofi-Synthelabo, Inc, Paris, France), which catalyses the oxidation of uric acid to allantoin, a highly water-soluble metabolite readily excreted by the kidneys. Patients and Methods: We administered Rasburicase intravenously, at 0.15 or 0.20 mg/kg, for 5 to 7 consecutive days to 131 children, adolescents, and young adults with newly diagnosed leukemia or lymphoma, who ei; ther presented with abnormally high plasma uric acid concentrations or had large tumor cell burdens. Blood levels of uric acid, creatinine, phosphorus, and potassium were measured daily. The pharmacokinetics of Rasburicase, the urinary excretion rate of allantoin, and antibodies to Rasburicase were also studied. Results: At either dosage, the recombinant enzyme produced a rapid and sharp decrease in plasma uric acid concentrations in all patients. The median level decreased by 4 hours after treatment, from 9.7 to 1 mg/dL (P = .0001), in the 65 patients who presented with hyperuricemia, and from 4.3 to 0.5 mg/dL (P = .0001) in the remaining 66 patients. Despite cytoreductive chemotherapy, plasma uric acid concentrations remained low throughout the treatment (daily median level, 0.5 mg/dL). The urinary excretion rate of allantoin increased during Rasburicase treatment, peaking on day 3. Serum phosphorus concentrations did not change significantly during the first 3 days of treatment, decreased significantly by day 4 in patients presenting with hyperuricemia (P = .0003), and fell within the normal range in all patients by 48 hours after treatment. Serum creatinine levels decreased significantly after 1 day of treatment in patients with or without hyperuricemia at diagnosis (P = .0003 and P = .02, respectively) and returned fa normal range in all patients by day 6 of treatment. Toxicity was negligible, and none of the patients required dialysis. The mean plasma half-lives of the agent were 16.0 +/- 6.3 (SD) hours and 21.1 +/- 12.0 hours, respectively, in patients treated at dosages of 0.15 or 0.20 mg/kg. Seventeen of the 121 assessable patients developed antibodies to the enzyme. Conclusion: Rasburicase is safe and highly effective for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma. (C) 2001 by American Society of Clinical Oncology.
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页码:697 / 704
页数:8
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