TITLE:
Successful prevention of tumor lysis syndrome using recombinant urate oxidase in patient with metastasic and bulky prostate rhabdomyosarcoma
AUTHORS:
Atsuko Watanabe, Ryuhei Tanaka
KEYWORDS:
Tumor Lysis Syndrome; Recombinant Urate Oxidase; Rhabdomyosarcoma
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.1,
January
13,
2014
ABSTRACT: Tumor lysis syndrome
(TLS) is a life-threatening oncological emergency that frequently occurs in
patients with hematological malignancies. It is becoming more common in
patients with solid tumors because of advances in molecular targeted therapies.
Recombinant urate oxidase (rUO) is effective at preventing and treating
hyperuricemia, but clinicians who treat adult patients with solid tumors are
generally not aware of this. In addition, the treatment guidelines for TLS do
not include indications for rUO treatment for chemosensitive sarcoma. We report
an adolescent case of metastatic rhabdomyosarcoma (RMS), in which clinical TLS
was successfully prevented using rUO. A 16-year-old Japanese male suffered from
urinary retention and bone pain and was diagnosed with prostate RMS combined
with multiple bone metastases and bone marrow involvement. He was judged to be
at high risk of clinical TLS because his prostate tumor was bulky and he
displayed laboratory TLS. rUO was administered during chemotherapy. Soon after
the initiation of chemotherapy, his disseminated intravascular coagulation
(DIC) got worse, and his lactate dehydrogenase (LDH) level was elevated due to
tumor lysis. However, his serum uric acid levels remained low, and he was
prevented from falling into acute renal failure. The planned regimen was
successfully completed without life-threatening complications, and the patient
achieved a complete response after 2 courses of chemotherapy. The international
TLS consensus panel developed recommendations for TLS prophylaxis, but did not
define the TLS risk classification of RMS. We recommend that RMS should be
treated like neuroblastoma because it grows rapidly and is highly
chemosensitive. Our patient was considered to be indicated for rUO because he displayed urinary retention, DIC, and
laboratory TLS before chemotherapy. These features might be useful as
indications for rUO therapy, which can safely support chemotherapy.