Abstract
Purpose:
To evaluate the frequency of metabolic complications and dialysis due to tumor lysis syndrome in patients with B-cell advanced-stage non-Hodgkin's lymphoma (NHL) and L3 leukemia at initiation of chemotherapy including the use of urate-oxidase.
Patients and methods:
Retrospective review of the clinical records of 410 patients with stage III and IV B-cell NHL and L3 leukemia treated in France and prospectively registered in the LMB89 protocol.
Results:
During the first week of chemotherapy, only 34 of 410 patients recorded metabolic problems that included hypocalcemia (< 70 mg/dl) in 24 patients, hyperphosphatemia (> 6.5 mg/dl) in 28 and elevation of creatinine > or = 2 SD in 16. Six patients underwent dialysis for life-threatening problems and a seventh as a preventive measure. In the other 27 cases, metabolic problems were successfully resolved using urate-oxidase in combination with alkaline hyperhydration. Among the 410 patients, one case of hemolysis was reported and there was no severe allergic reaction to urate-oxidase.
Conclusions:
Only 1.7% of patients in our study receiving urate-oxidase during their induction chemotherapy needed renal dialysis. Urate-oxidase was well tolerated, and used as prophylaxis and/or treatment of hyperuricemia and tumor lysis syndrome consistently gave a lower rate of renal and metabolic complications than in other series of similar patients.
Publication types
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Comparative Study
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Research Support, Non-U.S. Gov't
MeSH terms
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Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Cyclophosphamide / administration & dosage*
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Cyclophosphamide / adverse effects
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Cytarabine / administration & dosage*
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Cytarabine / adverse effects
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Doxorubicin / administration & dosage*
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Doxorubicin / adverse effects
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Etoposide / administration & dosage*
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Etoposide / adverse effects
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Female
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France
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Humans
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Hydrocortisone / administration & dosage*
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Hydrocortisone / adverse effects
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Leucovorin / administration & dosage*
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Leucovorin / adverse effects
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Lymphoma, B-Cell / drug therapy*
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Lymphoma, B-Cell / mortality
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Lymphoma, B-Cell / pathology
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Male
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Methotrexate / administration & dosage*
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Methotrexate / adverse effects
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Neoplasm Staging
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / mortality
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
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Prednisone / administration & dosage*
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Prednisone / adverse effects
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Retrospective Studies
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Risk Assessment
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Sensitivity and Specificity
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Survival Rate
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Treatment Outcome
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Tumor Lysis Syndrome / drug therapy*
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Tumor Lysis Syndrome / etiology*
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Tumor Lysis Syndrome / mortality
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Urate Oxidase / administration & dosage
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Urate Oxidase / adverse effects*
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Vincristine / administration & dosage*
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Vincristine / adverse effects
Substances
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Cytarabine
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Vincristine
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Etoposide
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Doxorubicin
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Cyclophosphamide
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Urate Oxidase
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Leucovorin
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Prednisone
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Hydrocortisone
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Methotrexate