Effectiveness of rasburicase 45 mg in the treatment of tumor lysis syndrome related hyperuricemia summary

This PACUPod episode explores Schlueter et al.’s retrospective cohort study on a single fixed 4.5 mg intravenous dose of rasburicase for tumor lysis syndrome (TLS)–related hyperuricemia. Patients were stratified by baseline uric acid into moderate (12 to <15 mg/dL) and high (≥15 mg/dL) groups. The findings show rapid uric acid reduction in both groups, with no significant difference in clinical outcomes, suggesting that a fixed-dose approach could simplify dosing, reduce costs, and expand access—especially in resource-limited settings. The discussion covers the study’s real-world design, lack of a comparator, and limitations, while highlighting safety considerations (G6PD deficiency screening), the need for careful monitoring of renal function and electrolytes, and the potential interference of rasburicase with uric acid assays requiring prompt processing. Practical implications include early intervention, streamlined pharmacy workflow, and potential guideline integration; the episode also notes that most patients did not require repeat dosing and calls for prospective trials comparing fixed-dose versus weight-based regimens to assess long-term renal outcomes and cost-effectiveness.