Timing of Rasburicase in Tumor Lysis Syndrome

Standard treatment for patients with tumor lysis syndrome (TLS) includes medications that lower uric acid: allopurinol, febuxostat, rasburicase*, or a combination. Rasburicase rapidly lowers plasma uric acid, but its high cost limits its use. The studies that led to rasburicase’s U.S. FDA approval only evaluated its effect on uric acid levels, and few subsequent studies have included clinical outcomes. In a U.S. multicenter, retrospective study of nearly 1300 adults hospitalized with high-tumor-burden malignancy (mostly hematologic) and TLS, researchers compared patients who received rasburicase within 12 hours (about half of patients) with those who received no (or delayed) rasburicase.