Elitek (rasburicase) / Sanofi - LARVOL DELTA

An explosive onset: Tumor lysis syndrome in newly diagnosed Mantle Cell Lymphoma. (ASH 2025) - "Patient was managed with aggressive intravenous hydration, rasburicase and was treated for hyperkalemia...Additionally, it stresses the necessity to vigorously screen patients admitted with malignancy and high tumour burden for TLS, even when they do not receive cytotoxic treatment. TLS management includes adequate hydration, the use of uric acid-lowering therapies and minimisation of potassium intake."

Acute Kidney Injury • Atrial Fibrillation • Cardiovascular • CNS Disorders • Endocrine Disorders • Epilepsy • Hematological Malignancies • Hepatology • Lymphoma • Mantle Cell Lymphoma • Metabolic Disorders • Nephrology • Oncology • Renal Disease • Solid Tumor

Registration and characterization of patients with Glucose-6-Phosphate Dehydrogenase Deficiency in Spain: A real-world study of the Spanish Erythropathology Group (GEE) (ASH 2025) - "Drug-relatedcauses accounted for 5%, with the most common medications being primaquine, rasburicase, COX-2inhibitors, and chemotherapy/antibiotics.The median hemoglobin during crises was 7.5 g/dL (range 3.9–11.1), while outside of crises it was 13.1g/dL (range 10.9–15.3). Our data highlight the importance of diagnosis to prevent acute hemolytic crises—the main reason fortesting in our cohort. In contrast, pre-treatment testing represented a small percentage of cases.We must reconsider the target population for screening and the most appropriate method to implementit, in order to identify not only affected individuals but also carriers of the disease. Finally, it is worthnoting the high genetic variability observed in our country, attributable to the inclusion of patients fromdiverse geographic Background s.No conflicts of interest."

Clinical • Real-world • Real-world evidence • Gastroenterology • Genetic Disorders • Hematological Disorders • Infectious Disease • Malaria • Metabolic Disorders • G6PD

Leukapheresis for acute leukemia with hyperleukocytosis: Line complications, resource utilization, and early mortality outcomes (ASH 2025) - "Median uric acid for the cohort was7.9 mg/dL; 61% (n=22) required rasburicase for significant TLS, with a median uric acid of 10.3 mg/dL inthis subgroup...In this single-center cohort, leukapheresis was associated with low rates of line-related complications,limited ICU resource utilization, and rapid initiation of chemotherapy. Moreover, no patients requireddialysis for TLS after induction chemotherapy. Early mortality rates aligned with prior studies, suggestingleukapheresis remains a reasonable management strategy for select patients with acute leukemia andhyperleukocytosis."

HEOR • Acute Lymphocytic Leukemia • Acute Myelogenous Leukemia • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Hematological Malignancies • Infectious Disease • Leukemia • Pulmonary Disease • Respiratory Diseases

Cladribine-based low-intensity therapy is safe and effective in patients with newly diagnosed Acute Myeloid Leukemia (AML) and renal impairment (ASH 2025) - P2 | "As a result, clinical drug references empiricallyrecommend dose reduction of cladribine for pts with a creatinine clearance (CrCl) 50 K/µL at 36 days...Two pts (13%) experienced laboratory tumor lysis syndrome (TLS) and 6 ptsreceived rasburicase to prevent or treat TLS... The presence of renal dysfunction in pts with newly diagnosed AML can pose a majorchallenge, often limiting the optimal use of highly effective therapies based on inadequate data.Treatment with cladribine, without dose modifications, did not result in significant or unanticipatedtoxicities among pts with impaired kidney function and may be considered as part of the treatmentbackbone for these pts. Close monitoring of kidney function and TLS management is necessary. Futureclinical trials confirming these findings in pts with impaired kidney function are warranted to help expandavailability of effective therapy."

Clinical • Acute Myelogenous Leukemia • Atrial Fibrillation • Chronic Kidney Disease • Coronary Artery Disease • Diabetes • Diabetic Nephropathy • Febrile Neutropenia • Hematological Malignancies • Hypertension • Infectious Disease • Leukemia • Metabolic Disorders • Myelodysplastic Syndrome • Nephrology • Renal Disease • Type 2 Diabetes Mellitus • FLT3

Impact of angiotensin converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARB) on tumor lysis syndrome, acute kidney injury, and rasburicase use in patients undergoing chemotherapy for hematologic malignancies (ASH 2025) - "This hasimportant implications not only for patient outcomes but also for the financial burden related tosupportive care, including rasburicase use. Clinicians should carefully consider the risks andbenefits of continuing ACEis/ARBs during the acute treatment phase, particularly when the risk ofTLS is highest."

Clinical • Acute Kidney Injury • Acute Lymphocytic Leukemia • Acute Myelogenous Leukemia • Adult T-Cell Leukemia-Lymphoma • B Cell Lymphoma • Burkitt Lymphoma • Chronic Lymphocytic Leukemia • Diabetes • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Hypertension • Leukemia • Lymphoblastic Lymphoma • Lymphoma • Mantle Cell Lymphoma • Metabolic Disorders • Nephrology • Non-Hodgkin’s Lymphoma • Oncology • Peripheral T-cell Lymphoma • Renal Disease • T Cell Non-Hodgkin Lymphoma

Evaluation of ventoclax initiation prophylaxis and monitoring outcomes at each dose level and time point in patients with chronic lymphocytic leukemia: A real-world experience (ASH 2025) - "Background : Venetoclax (VEN)+obinutuzumab (VO) is an effective therapy for CLL/SLL requiring regularmonitoring for tumor lysis syndrome (TLS) during VEN ramp-up...Adult pts with CLL/SLL were eligible if they: (1) startedVO per-label outside of a clinical trial in 1L, or immediately after exposure in 1L to agents with differentmechanisms of action (i.e., BTKi, anti-CD20 only) of <30 days; (2) prior to VEN start, had either (i) lowphysician-determined tumor burden (TB) (i.e., all lymph nodes [LN] <5 cm and ALC <25 x 109/L), or (ii)medium physician-determined TB (i.e., any LN ≥5-<10 cm or ALC ≥25 x 109/L) with creatinine clearance≥80 mL/min; (3) had no strong CYP3A inhibitors or prophylactic rasburicase from 3 days prior to VENstart until end of VEN ramp-up; and (4) had VEN ramp-up in an outpatient setting.TB-related labs/imaging was assessed from 2 months prior to obinutuzumab initiation (i.e., index date)until VEN start...Prior to VEN ramp-up, all pts..."

Clinical • Real-world • Real-world evidence • Chronic Lymphocytic Leukemia • Diabetes • Hematological Disorders • Hematological Malignancies • Leukemia • Neutropenia • IGH • TP53

Rasburicase Real-World Usage for the Prevention and Treatment of Tumor Lysis Syndrome in Adults and Children. (PubMed, Ann Pharmacother) - "In the adult and pediatric population, a single rasburicase dose of 0.15 to 0.2 mg/kg, capped at 6 mg, represents an effective, safe, and more cost-effective option for both the prevention and treatment of TLS. Further studies are warranted to compare single versus multiple dosing in pediatric population and to identify potential risk factors for nonresponders."

Journal • Real-world evidence • Oncology • Pediatrics

Tumor Lysis Syndrome Induced by Hormonal Therapy in Metastatic Prostate Cancer: A Case Report. (PubMed, Cureus) - "Hormone therapy with degarelix was initiated...TLS management was initiated, which included aggressive intravenous hydration, hypouricemic therapy with rasburicase, and correction of electrolyte disturbances...In all reported treatment-related TLS cases in prostate cancer, mortality was universal despite aggressive supportive management. This case illustrates a rare instance of TLS occurring after initiation of gonadotropin-releasing hormone antagonist therapy in metastatic prostate cancer, highlighting the need for careful risk assessment, close biochemical monitoring, and prompt recognition and management of TLS, especially in patients with high tumor burden."

Journal • Acute Kidney Injury • Anorexia • Genito-urinary Cancer • Hematological Disorders • Hematological Malignancies • Hepatology • Metabolic Disorders • Nephrology • Oncology • Pain • Prostate Adenocarcinoma • Prostate Cancer • Renal Disease • Solid Tumor

Rasburicase vs. allopurinol: mortality in hematological malignancies post anti-hyperuricemic therapy - real-world study. (PubMed, Support Care Cancer) - "Following successful PS matching of TLS-risk factors, this study suggests rasburicase statistically significantly reduces TLS-associated mortalities compared to allopurinol."

Journal • Real-world evidence • Hematological Disorders • Hematological Malignancies • Oncology

Comparing Cairo Bishop and Howard Criteria for Identifying Clinically Meaningful Tumor Lysis Syndrome Among Acute Myeloid Leukemia Patients Treated with Venetoclax and Hypomethylating Agents: A Single Center Experience (ASH 2023) - "56 pts received allopurinol ≥72 hours prior to starting ven, 21 received ≥2L of IV fluid per day starting at least the day prior to ven, and 56 had TLS labs measured every 8-12 hours during the first 3 days following ven initiation...We defined significant TLS as pts who required hospitalization (if started treatment outpatient) or ICU transfer, received rasburicase, developed AKI, or had treatment held due to TLS...Of the pts who developed significant TLS, a majority had spontaneous TLS; only 5 pts had significant TLS occur after starting ven. We also found that the Howard criteria for TLS better identify pts who will have adverse outcomes from TLS and may be a more clinically meaningful set of criteria to use in future studies."

Clinical • Acute Kidney Injury • Acute Myelogenous Leukemia • Hematological Malignancies • Leukemia • Nephrology • Oncology • Renal Disease • FLT3 • NPM1

Outpatient Administration of First Cycle Azacitidine-Venetoclax in Acute Myeloid Leukemia Patients Compared to Inpatient Care: Preliminary Results of a Single-Center Retro-Prospective Study (ASH 2024) - "Therapy regimen followed standard guidelines.All received TLS prophylaxis with rasburicase and/or allopurinol depending on baseline uric acid levels and TLS risk. No differences were seen in leukocytes, neutrophils and platelet count between infected and not infected patients.Regarding secondary endpoints, between the two cohorts there was no significant difference in OS at 12 months (inpts : 51.6%, CI 21.6-74.5; outpts : 40.5%, CI 15.2-64.8; p=0.75) or PFS (median PFS : inpts not reached; outpts 21.14 months; p=0.59).Conclusions : Our preliminary results, based on a retro-prospective analysis, suggest that outpatient administration of C1 AZA-Ven could be a viable alternative to inpatient care, potentially improving patient quality of life and reducing healthcare costs. Further studies with larger sample sizes are warranted to confirm these findings and to identify patients suitable for therapy initiation in an outpatient setting and to determine what baseline..."

Clinical • Acute Myelogenous Leukemia • Hematological Malignancies • Infectious Disease • Leukemia • Oncology

A Phase 2 Study of Minimal Residual Disease (MRD)-Adapted Front Line Venetoclax and Obinutuzumab in Fit Patients with Chronic Lymphocytic Leukemia (CLL): Effect of Obinutuzumab on Tumor Lysis Syndrome (TLS) Risk and Safety of Outpatient Venetoclax Dose Escalation (ASH 2023) - P2 | "For pts who remained high TLS risk at the time of V initiation, TLS ppx throughout dose escalation included allopurinol to start at least 3 days prior to V initiation, sevelamer to start 12 hours prior to V initiation, and oral intake of ≥2 L water daily. On days of dose escalation, ppx additionally included kayexalate, rasburicase, and IV normal saline on D1 and D2 of each dose escalation... A single cycle of O effectively reduced TLS risk prior to introduction of V escalation with most pts achieving low or med TLS risk by C1D22. Notably, 90% of pts with high pre-tx TLS risk converted to low or med risk following C1 of O allowing for outpatient V escalation per FDA label. Further, we demonstrate that V dose escalation can be safely accomplished in the outpatient setting with close monitoring regardless of TLS risk."

Clinical • Minimal residual disease • P2 data • Residual disease • Chronic Lymphocytic Leukemia • Hematological Disorders • Hematological Malignancies • Leukemia • Neutropenia • Oncology • Thrombocytopenia

Omission of Venetoclax Ramp-up Dosing during Induction Therapy for Acute Myeloid Leukemia in Combination with DNA Hypomethylating Agents Is Safe and Well-Tolerated (ASH 2024) - "All but two patients (98%, n=106) received decitabine as the companion HMA with 42% receiving >5 days of treatment (n=44, median 10 days [range 7-10]) and 58% receiving ≤5 days (n=62, median 5 days [range 4-5])...All cases resolved with administration of rasburicase and without end-organ damage...Recovery times for neutrophils and platelets and composite remission rates after 1 cycle of treatment were similar regardless of HMA duration when combined with venetoclax. These retrospective, single institution findings suggest that venetoclax can be safely administered at a dose of 100 mg daily with concurrent posaconazole and HMA and initiated without venetoclax ramp-up dosing."

Combination therapy • Acute Myelogenous Leukemia • Chronic Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Oncology

Real World Analysis of G6PD Testing Prior to the Use of Rasburicase in Hematologic Malignancies; A Single Center Experience (ASH 2023) - "G6PD testing was requested in 45% of patients being evaluated for hematologic malignancies. Of these, only 17. 7% had results available before the administration of Rasburicase."

Clinical • Real-world • Real-world evidence • B Cell Lymphoma • Burkitt Lymphoma • Chronic Lymphocytic Leukemia • Diffuse Large B Cell Lymphoma • Hematological Malignancies • High-grade B-cell lymphoma • Lymphoma • Metabolic Disorders • Non-Hodgkin’s Lymphoma • Oncology • T Acute Lymphoblastic Leukemia • T Cell Non-Hodgkin Lymphoma • G6PD

Delayed Presentation of IgG4-Related Disease and Subsequent Lymphoma in Phospholipase A2 Receptor (PLA2R)(-) Membranous Nephropathy (KIDNEY WEEK 2025) - "He was treated as low-risk PLA2R(-) primary MN with lisinopril...He was given rasburicase for spontaneous tumor lysis, then polatuzumab, rituximab, cyclophosphamide, doxorubicin, and prednisolone chemoimmunotherapy...In this case, the submandibular gland, commonly involved in IgG4-RD, retained IgG4-rich features at DLBCL diagnosis. Alternatively, he may have had indolent lymphoma mimicking IgG4-RD, which transformed into DLBCL."

Acute Kidney Injury • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Fibrosis • Glomerulonephritis • Hematological Malignancies • Immunology • Indolent Lymphoma • Lymphoma • Nephrology • Non-Hodgkin’s Lymphoma • Renal Disease

The Potassium Trap: Recognizing Pseudohyperkalemia in Hematologic Malignancies (KIDNEY WEEK 2025) - "Case Description A 74-year-old male lost to follow-up after a diagnosis of chronic lymphocytic leukemia (CLL) three years ago, currently being treated with one month of acalabrutinib, was admitted after an outpatient workup revealed worsening leukocytosis...He was admitted for initiation of fludarabine, cyclophosphamide, and rituximab...He was started on fluids and given a dose of rasburicase for tumor lysis syndrome (TLS) prevention; Nephrology was consulted for potential dialysis initiation...The protocols ensure prompt treatment but could result in missing pseudohyperkalemia. It is imperative to confirm serum measurements with whole blood, especially in scenarios with discrepancies in clinical presentations and laboratory findings, to avoid complications like iatrogenic hypokalemia and unnecessary procedures."

Chronic Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Nephrology • Oncology

Hyperuricemia with Urate Nephropathy in the Setting of Leukemoid Reaction: A Case Report (KIDNEY WEEK 2025) - "With suspicion of a hematologic disease, relatively bland urinalysis, the massive amount of UA crystals seen on urine microscopy shown in the figure, as well as absence of other explanation for the renal impairment, urate nephropathy was suspected and Rasburicase was administered...Thus, hyperuricemia and acute urate nephropathy were likely related to the leukemoid reaction. We report this case to emphasize the importance of urine microscopy and to call for consideration of leukemoid reaction as a possible cause for hyperuricemia."

Case report • Clinical • Chronic Myelomonocytic Leukemia • Diabetes • Genetic Disorders • Gout • Hematological Disorders • Inflammatory Arthritis • Metabolic Disorders • Obesity • Renal Disease • Rheumatology • Type 2 Diabetes Mellitus

Early Treatment with Rasburicase and Kidney Replacement Therapy or Death in Patients with Tumor Lysis Syndrome (KIDNEY WEEK 2025) - "Similar findings were observed for secondary outcomes (Figure 1B). Conclusion In this multicenter cohort study of hospitalized adults with TLS, the risk of AKI-KRT or death was considerably lower in those who received early treatment with rasburicase compared to those who did not."

Clinical • Oncology

Pegloticase for Tumor Lysis Syndrome (KIDNEY WEEK 2025) - "In our analysis of 398 cases of TLS at UTMD Anderson Cancer Center in 2018, we found that almost 60% (240 cases) needed repeated doses of rasburicase, often up to 3 doses several days apart to bring the serum uric acid down to 6.0 and help with recovery of acute kidney injury (AKI). Conclusion Pegloticase is extremely effective and safe in cancer patients with severe tumor lysis syndrome. Uric acid levels were less than 1 for 14 days after a single dose and stayed below 3.5 for 30 days."

Acute Kidney Injury • Nephrology • Oncology • Renal Disease

Primary Liver Involvement in Mantle Cell Lymphoma: A Diagnostic Trap (ACG 2025) - "The patient developed spontaneous TLS requiring ICU-level care, vasopressors, CRRT, and rasburicase...Although hepatic MCL is rare, it can present with fulminant disease. Timely recognition may expedite diagnosis and guide appropriate management, especially in elderly or frail patients, where treatment must be individualized."

Anorexia • B Cell Non-Hodgkin Lymphoma • Biliary Cancer • Cholestasis • Chronic Lymphocytic Leukemia • Coronary Artery Disease • Gastroenterology • Geriatric Disorders • Hematological Malignancies • Hepatocellular Cancer • Hepatology • Hypotension • Leukemia • Liver Failure • Lymphoma • Mantle Cell Lymphoma • Non-Hodgkin’s Lymphoma • Palliative care • Pancreatic Cancer • Solid Tumor • CD5 • FCER2 • MME

When Newly Diagnosed Cirrhosis Conceals Cancer: Diagnosing CLL in a Patient With Alcohol Use Disorder, Lymphocytic Ascites, and Exudative Pleural Effusions (ACG 2025) - "Peripheral smear revealed reactive lymphocytes, and lymph node biopsy confirmed Rai stage IV CLL/SLL.Given his decompensated cirrhosis, which precluded standard CLL induction regimens, and concurrent AKI with hyperuricemia concerning for spontaneous tumor lysis, he was started on weekly rituximab monotherapy for disease debulking, along with allopurinol and rasburicase. Prominent paraesophageal, mesenteric, retroperitoneal, bilateral pelvic sidewall, and inguinal lymphadenopathy. Additional findings include mild omental stranding concerning for a neoplastic process, diffuse soft tissue anasarca, and a moderate right-sided pleural effusion with associated passive lung collapse."

Clinical • Pleural effusion • Addiction (Opioid and Alcohol) • Chronic Lymphocytic Leukemia • CNS Disorders • Fibrosis • Hematological Malignancies • Hepatology • Hodgkin Lymphoma • Immunology • Infectious Disease • Leukemia • Liver Failure • Lymphoma • Metabolic Disorders • Non-Hodgkin’s Lymphoma • Oncology • Portal Hypertension • Respiratory Diseases • Small Lymphocytic Lymphoma • Tuberculosis

A Rare Case of Tumor Lysis Syndrome Following Targeted Therapy in Metastatic BRAF-Mutated Colorectal Cancer (ACG 2025) - "She had recently initiated a new regimen of panitumumab and oral encorafenib for BRAF-mutated disease...Rasburicase and bicarbonate-containing fluids were initiated...TLS should remain on the differential in patients with solid tumors and high disease burden who present with acute renal failure and electrolyte disturbances after initiating cytotoxic or targeted therapy. Early recognition and prompt treatment can be lifesaving."

Clinical • Metastases • Acute Kidney Injury • Colorectal Cancer • Fatigue • Hematological Malignancies • Metabolic Disorders • Nephrology • Oncology • Renal Disease • Solid Tumor • BRAF

TUMOR LYSIS SYNDROME MANAGEMENT IN A RESOURCE-LIMITED SETTING WITH NO ACCESS TO RASBURICASE (SIOP 2025) - "Allopurinol was used in 15 (64%) patients. TLS, an unexpectedly frequent complication in ALL in our setting, can be effectively treated without Rasburicase despite a high frequency of hyperuricemia, with low mortality."

Acute Kidney Injury • Cardiovascular • CNS Disorders • Endocrine Disorders • Epilepsy • Metabolic Disorders • Nephrology • Oncology • Renal Disease

Tumor Lysis Syndrome Triggered by Acalabrutinib in Chronic Lymphocytic Leukemia (CLL): Diagnostic and Therapeutic Implications. (PubMed, Cureus) - "Prompt management with intravenous hydration, Rasburicase, calcium supplementation, and potassium-lowering agents led to gradual metabolic correction. This case highlights the importance of recognizing the potential for TLS even in slow-growing hematologic malignancies like CLL, especially in patients with high tumor burden or compromised renal function. Clinicians must maintain a high index of suspicion and initiate appropriate prophylactic measures when starting targeted therapies, particularly BTK inhibitors, to prevent life-threatening complications."

Journal • Acute Kidney Injury • Chronic Lymphocytic Leukemia • Endocrine Disorders • Hematological Disorders • Hematological Malignancies • Leukemia • Metabolic Disorders • Nephrology • Oncology • Renal Disease • Thrombocytopenia • CD20 • CD5 • FCER2

TUMOR LYSIS SYNDROME AND EXTREME HYPERFERRITINEMIA IN THE SETTING OF METASTATIC PROSTATE CANCER: A CASE REPORT (CHEST 2025) - "He completed a cycle of cabazitaxel and carboplatin 14 weeks prior and had since continued leuprolide and abiraterone...Rasburicase was administered... TLS in prostate cancer is an exceptionally rare phenomenon, with only a handful of reported cases. This case highlights the need to maintain clinical suspicion for TLS even in the case of solid organ malignancies. There may be a role for G6PD deficiency screening in at-risk patients diagnosed with metastatic malignancy."

Case report • Clinical • Metastases • Castration-Resistant Prostate Cancer • CNS Disorders • Genito-urinary Cancer • Hematological Malignancies • Hemophagocytic lymphohistiocytosis • Immunology • Metabolic Disorders • Musculoskeletal Pain • Oncology • Prostate Cancer • Rare Diseases • Solid Tumor • Vascular Neurology