The Use of Single-Dose Rasburicase for the Prevention and Treatment Tumor Lysis Syndrome in Pediatric Patients: A Narrative Review

Background. Rasburicase is licensed for the management of tumor lysis syndrome (TLS) at a daily dose of 0.15-0.2 mg/kg for 5-7 days. The use of a single-dose treatment is popular in adult oncology but information in pediatric use is limited. Methods. From a literature search, all case reports and series, comparative studies, and reviews in which pediatric oncology patients received single-dose rasburicase were selected for further analysis. Treatment success was determined by normalization of serum uric acid in the absence of serious complications. Results. Thirteen articles with a total of 348 children were included. A fixed-dose regimen was used in 195, while 153 received weight-based dosing. With fixed dosing, successful treatment was seen in 91.8% and 89.2% at rasburicase doses ≥ 3mg and 1.5mg, respectively (P=0.23). However, there were four mortalities in the lower-dose group. For weight-based dosing, success was observed in 89.2% and 66.7% at doses ≥ 0.15 mg/kg and < 0.15mg/kg, respectively (P=0.0029). One child required dialysis in the lower-dose group. Conclusions. Single-dose rasburicase for the prevention and treatment of TLS in pediatric oncology is a pharmacoeconomically appealing approach. A fixed dose of at least 3mg or 0.15mg/kg by body weight is recommended.