Sarah McKenna1, Alexandra Cheung2, Amanda Wolfe3, Brenda L Coleman4, Michael E Detsky5, Laveena Munshi6, Dawn Maze7, Lisa Burry8. 1. PharmD, ACPR, is with the Department of Pharmacy, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario. 2. , BScPhm, PharmD, is with the Department of Pharmacy, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario. 3. (formerly Amanda Jacques), BScPharm, ACPR, was, at the time this study was conducted, with the Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network, and the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. She is now with the Department of Pharmacy, Bruyère Continuing Care, Ottawa, Ontario. 4. PhD, is with Infectious Disease Research, Mount Sinai Hospital, Sinai Health System, and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario. 5. MD, MSHP, FRCPC, is with the Interdepartmental Division of Critical Care, University Health Network/Sinai Health System, and the Interdepartmental Division of Critical Care and Faculty of Medicine, University of Toronto, Toronto, Ontario. 6. MD, MSc, FRCPC, is with the Interdepartmental Division of Critical Care, University Health Network/Sinai Health System, Toronto, Ontario. 7. MD, MSc, FRCPC, is with the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, and the Faculty of Medicine, University of Toronto, Toronto, Ontario. 8. PharmD, is with the Department of Pharmacy, Mount Sinai Hospital, Sinai Health System, and the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.
Abstract
BACKGROUND: Tumour lysis syndrome (TLS) occurs when lysis of malignant cells causes electrolyte disturbances and potentially organ dysfunction. Guidelines recommending preventive therapy according to TLS risk are based on low-quality evidence. OBJECTIVES: The primary objective was to characterize utilization of TLS preventive strategies through comprehensive description of current practice. Secondary objectives were to determine TLS incidence, to compare use of preventive strategies among intermediate- and high-risk patients, and to describe TLS treatment strategies. METHODS: This retrospective chart review examined data for patients with newly diagnosed hematologic malignancy who were admitted to an oncology centre and/or affiliated intensive care unit between October 2015 and September 2016 in Toronto, Ontario, Canada. RESULTS: Fifty-eight patients (29 at intermediate risk, 29 at high risk) were eligible for inclusion. Use of preventive allopurinol, IV bicarbonate, and furosemide was similar between groups. Rasburicase was more frequently used for high-risk patients (3% [1/29] of intermediate-risk patients versus 36% [9/25] of high-risk patients; p = 0.003). In 4 (14%) of the intermediate-risk patients and 2 (8%) of the high-risk patients, TLS developed during the admission. TLS was observed in 10% (1/10) of patients who received preventive rasburicase and 11% (5/44) of those who did not (p > 0.99), and in 9% (4/45) of patients who received preventive IV bicarbonate and 25% (2/8) of those who did not (p = 0.22). Treatment strategies included rasburicase, IV bicarbonate, furosemide, and renal replacement therapy. CONCLUSIONS: In this retrospective chart review, rasburicase was more commonly used for high-risk patients, whereas the use of other agents was similar between risk groups. This pattern of use is inconsistent with guidelines, which recommend that all high-risk patients receive rasburicase. There was no difference in TLS incidence between patients who did and did not receive preventive rasburicase or IV bicarbonate. Further prospective studies are needed to inform management of patients with malignancies who are at intermediate or high risk of TLS. 2019 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
BACKGROUND: Tumour lysis syndrome (TLS) occurs when lysis of malignant cells causes electrolyte disturbances and potentially organ dysfunction. Guidelines recommending preventive therapy according to TLS risk are based on low-quality evidence. OBJECTIVES: The primary objective was to characterize utilization of TLS preventive strategies through comprehensive description of current practice. Secondary objectives were to determine TLS incidence, to compare use of preventive strategies among intermediate- and high-risk patients, and to describe TLS treatment strategies. METHODS: This retrospective chart review examined data for patients with newly diagnosed hematologic malignancy who were admitted to an oncology centre and/or affiliated intensive care unit between October 2015 and September 2016 in Toronto, Ontario, Canada. RESULTS: Fifty-eight patients (29 at intermediate risk, 29 at high risk) were eligible for inclusion. Use of preventive allopurinol, IV bicarbonate, and furosemide was similar between groups. Rasburicase was more frequently used for high-risk patients (3% [1/29] of intermediate-risk patients versus 36% [9/25] of high-risk patients; p = 0.003). In 4 (14%) of the intermediate-risk patients and 2 (8%) of the high-risk patients, TLS developed during the admission. TLS was observed in 10% (1/10) of patients who received preventive rasburicase and 11% (5/44) of those who did not (p > 0.99), and in 9% (4/45) of patients who received preventive IV bicarbonate and 25% (2/8) of those who did not (p = 0.22). Treatment strategies included rasburicase, IV bicarbonate, furosemide, and renal replacement therapy. CONCLUSIONS: In this retrospective chart review, rasburicase was more commonly used for high-risk patients, whereas the use of other agents was similar between risk groups. This pattern of use is inconsistent with guidelines, which recommend that all high-risk patients receive rasburicase. There was no difference in TLS incidence between patients who did and did not receive preventive rasburicase or IV bicarbonate. Further prospective studies are needed to inform management of patients with malignancies who are at intermediate or high risk of TLS. 2019 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
Authors: S Vadhan-Raj; L E Fayad; M A Fanale; B Pro; A Rodriguez; F B Hagemeister; C E Bueso-Ramos; X Zhou; P W McLaughlin; N Fowler; J Shah; R Z Orlowski; F Samaniego; M Wang; J E Cortes; A Younes; L W Kwak; N J Sarlis; J E Romaguera Journal: Ann Oncol Date: 2011-10-19 Impact factor: 32.976
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