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Annals of Oncology 13:789-795, 2002
© 2002 European Society for Medical Oncology

Original Paper

Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia, treated in the Société Française d’Oncologie Pédiatrique LMB89 protocol

C. Patte1,+, C. Sakiroglu1, S. Ansoborlo2, A. Baruchel3, E. Plouvier4, H. Pacquement5 and A. Babin-Boilletot6,§

1Institut Gustave Roussy, Villejuif, 2Centre Hospitalier Universitaire, Bordeaux; 3Hôpital St Louis, Paris; 4Centre Hospitalier Universitaire, Besançon; 5Institut Curie, Paris; 6Institut de Puériculture, Strasbourg, France

Received 14 May 2001; revised 7 December 2001; accepted 12 December 2001.

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 >=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.

Key words: B-cell lymphoma, hyperuricemia, L3 leukemia, LMB protocol, tumor lysis syndrome, urate-oxidase


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