What are the strategies for primary prevention for tumor lysis syndrome?
Allopurinol prophylaxis significantly reduces the risk of urate deposition in the kidneys in patients with a high tumor burden who are undergoing induction chemotherapy. The recombinant-urate oxidase inhibitor rasburicase is U.S. Food and Drug Administration approved for use in the prevention of urate nephropathy in pediatric patients with severe hyperuricemia who receive chemotherapy that is expected to cause tumor lysis syndrome. This agent also has been shown to decrease serum uric acid levels and reduce the incidence of AKI in small, uncontrolled trials of adult patients. Candidates for rasburicase prophylaxis are patients at increased risk for tumor lysis syndrome, including those with serum uric acid levels higher than 7.5 mg/dL (0.4 mmol/L), high-turnover tumors (such as hematologic malignancies) with elevated serum lactate dehydrogenase levels, decreased intravascular volume status, and tumor infiltration of the kidneys, and patients undergoing aggressive-intensity cytoreductive therapy.