Elitek (rasburicase) / Sanofi - LARVOL DELTA

Don't Miss It! Methemoglobinemia: Inherited and Acquired (ASH 2026) - "She discusses the populations and exposures that should raise suspicion, including dapsone and other chronic oxidant medications, rasburicase prescribing, peri-procedural topical anaesthetics, and recreational nitrite use. A mechanism-based framework that predicts each agent's clinical time course will be presented."

Genetic Disorders • Hematological Disorders

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

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

SAVE (Safe Accelerated Venetoclax Escalation): Initial results of a prospective, phase Ib study of venetoclax with an accelerated dose ramp-up in patients with CLL. (ASCO 2023) - P1 | "19 pts received obinutuzumab with VEN, and 1 pt received VEN monotherapy...One pt with medium TLS risk had lab TLS (phos and uric acid peaked at 8.7 mg/dL) after the first VEN 400 mg dose, which resolved with sevelamer and rasburicase, thereby prolonging the ramp-up to 6 days... Our early data suggest that an inpatient, accelerated 5-day VEN ramp-up is feasible in CLL, with a low rate of TLS, even among patients with medium or high risk of TLS. The study is currently ongoing. Clinical trial information: NCT04843904."

Clinical • P1 data • Chronic Lymphocytic Leukemia • Hematological Disorders • Neutropenia • Thrombocytopenia

Rapid G6PD Screening Workflow for Timely Tumor Lysis Syndrome Management in Pediatric Oncology. (PubMed, Ann Clin Lab Sci) - "Rapid G6PD screening supported timely TLS management. Reflex quantitative testing remains essential, as interpretation varies substantially between qualitative screening, quantitative reference intervals, and WHO activity-based criteria."

Journal • Hematological Disorders • Metabolic Disorders • Oncology • Pediatrics

Isolated Gastric Variceal Hemorrhage From Sinistral Portal Hypertension in JAK2 V617F-Positive Myeloproliferative Neoplasm (ACG 2026) - "Case Description/ A 48-year-old male with JAK2 V617F-positive MPN and chronic portal and splenic vein thrombosis, noncompliant with hydroxyurea and warfarin therapy, presented with 1 episode of hematemesis...He was resuscitated with vasopressors, octreotide, and pantoprazole infusion, and treated with rasburicase for TLS...He was ultimately transitioned to ruxolitinib as outpatient therapy, with normalization of counts and resolution of bleeding at follow-up...Figure: Figure 2. Esophagogastroduodenoscopy showing extensive isolated gastric varices (IGV1 and IGV2) and an actively bleeding, ulcerated varix (image 14), which was clipped endoscopically."

Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Hypertension • Myeloproliferative Neoplasm • Portal Hypertension • Thrombocytosis • Thrombosis • Varicose Veins • JAK2

Breaking Bad: Spontaneous Tumor Lysis Syndrome in Hepatic Adenocarcinoma, an Uncommon Complication of a Rare Malignancy (ACG 2026) - "Nephrology was consulted, and treatment with rasburicase, allopurinol, and bicarbonate infusion was initiated. Figure: Table 1. Cairo-Bishop Criteria for TLS"

Acute Coronary Syndrome • Biliary Cancer • Cholangiocarcinoma • Endocrine Disorders • Hematological Malignancies • Hepatitis C • Hepatocellular Cancer • Hepatology • Infectious Disease • Metabolic Disorders • Movement Disorders • Nephrology • Oncology • Renal Disease • Respiratory Diseases • Restless Legs Syndrome • Sleep Disorder • Solid Tumor • CK19 • KRT19

RASBURICASE-INDUCED METHEMOGLOBINEMIA SUCCESSFULLY TREATED WITH HIGH-DOSE VITAMIN C IN THE ABSENCE OF GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY (CHEST 2026) - No abstract available

Hematological Disorders • Metabolic Disorders

Strategies for Risk Stratification of Spontaneous Tumor Lysis Syndrome in Small Cell Lung Carcinoma: A Case Series (IASLC-WCLC 2026) - "Treatment failed with rasburicase...Conclusions : STLS is a devastating complication of SCLC. These cases and recent literature establish a possible criteria set to consider for screening for risk of STLS."

Clinical • Acute Kidney Injury • CNS Disorders • Endocrine Disorders • Epilepsy • Hematological Malignancies • Hepatocellular Cancer • Hepatology • Lung Cancer • Metabolic Disorders • Nephrology • Oncology • Pulmonary Disease • Renal Disease • Respiratory Diseases • Small Cell Lung Cancer • Solid Tumor

The global landscape of pediatric hyperuricemia research: a bibliometric roadmap to mechanisms, management, and future therapeutics (1997-2024). (PubMed, Transl Pediatr) - "Keyword co-occurrence analysis delineated three dominant research clusters: (I) core clinical management ("hyperuricemia", "allopurinol", "rasburicase"); (II) cardiometabolic comorbidities ("obesity", "hypertension", "metabolic syndrome"); and (III) epidemiological and risk factor profiling ("children", "uric acid", "prevalence"). Our roadmap highlights four critical frontiers: elucidating developmental-stage-specific pathological mechanisms, establishing validated diagnostic thresholds, evaluating the long-term safety and efficacy of both pharmacological and non-pharmacological interventions, and defining strategies for lifelong management to mitigate adult-onset complications. We advocate for enhanced international and interdisciplinary collaboration as the cornerstone for accelerating progress in this vital field."

Journal • Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • Genetic Disorders • Hypertension • Metabolic Disorders • Nephrology • Obesity • Pediatrics • Renal Disease

Etiology of methemoglobinemia in the National Poison Data System®: an observational study. (PubMed, Clin Toxicol (Phila)) - "Other classic xenobiotics such as dapsone, phenazopyridine, and local anesthetics were frequently treated but rarely fatal. Xenobiotics not typically linked to methemoglobinemia, such as acetaminophen and rasburicase, also appeared among the top ten causes. Non-pharmaceutical nitrates/nitrites were the leading causes of methemoglobinemia, methylene blue use, and mortality Other leading contributors included both classically recognized causes of methemoglobinemia, as well as xenobiotics not commonly associated with the condition. These findings underscore the need for further research on xenobiotics associated with methemoglobinemia and heightened awareness of both established and emerging etiologies."

Journal • Observational data • Anesthesia • Hematological Disorders • Infectious Disease

When metabolic emergencies collide: A case of concurrent diabetic ketoacidosis and tumor lysis syndrome, AJEM42616.R1. (PubMed, Am J Emerg Med) - "This case underscores the importance of considering concurrent TLS in patients with recently treated chemosensitive malignancies who present with DKA, acute kidney injury, hyperuricemia, or hyperphosphatemia. Recognition of TLS may prompt disease-specific interventions including rasburicase administration, oncology consultation, and intensive monitoring beyond standard DKA management."

Journal • Acute Kidney Injury • Diabetes • Hypotension • Infectious Disease • Lung Cancer • Metabolic Disorders • Nephrology • Oncology • Renal Disease • Solid Tumor

Spontaneous Tumor Lysis Syndrome Revealing Advanced Ovarian Carcinoma: From Oncologic Emergency to Complete Pathologic Response. (PubMed, Cureus) - "The patient was treated with aggressive intravenous hydration, rasburicase, electrolyte correction, and close multidisciplinary monitoring, resulting in rapid normalization of metabolic abnormalities and recovery of renal function without dialysis. Following stabilization, the patient underwent neoadjuvant carboplatin-paclitaxel chemotherapy followed by interval cytoreductive surgery...This case highlights spontaneous TLS as a rare initial manifestation of advanced ovarian carcinoma and emphasizes the importance of early recognition and prompt intervention. Timely management may reverse life-threatening metabolic complications, facilitate definitive oncologic treatment, and result in favorable long-term outcomes."

Journal • Acute Kidney Injury • Endocrine Disorders • Hematological Disorders • Hematological Malignancies • Metabolic Disorders • Nephrology • Oncology • Ovarian Cancer • Pulmonary Disease • Renal Disease • Solid Tumor • CEACAM5

Wohlfahrtiimonas chitiniclastica Bacteremia Associated With Maggot-Infested Ulcers and Tumor Lysis Syndrome in Ohio, USA: A Case Report. (PubMed, Case Rep Infect Dis) - "The clinical course was complicated by metastatic cancer and spontaneous tumor lysis syndrome (uric acid 14.6 mg/dL, LDH 2157 U/L) that improved following rasburicase therapy. The patient received empiric intravenous piperacillin-tazobactam for approximately 24 days, followed by de-escalation to ceftriaxone...This case illustrates W. chitiniclastica bacteremia in Ohio, USA, and highlights diagnostic challenges including initial misidentification by conventional methods, the importance of MALDI-TOF MS for definitive identification, and possible vector adaptation to regional muscid fly species. The coisolation of T. praeacuta underscores the complex wound microbiome associated with chronic neglected ulcers."

Journal • Infectious Disease • Oncology • Septic Shock

Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial. (PubMed, BMJ) - "Among adults with TLS, early rasburicase treatment for TLS was associated with about one third lower risk of acute kidney injury requiring kidney replacement therapy or death compared with delayed or no rasburicase treatment."

Journal • Acute Kidney Injury • Hematological Disorders • Hematological Malignancies • Nephrology • Oncology • Renal Disease • Solid Tumor

An uncommon encounter with tumor lysis syndrome in colorectal cancer. (PubMed, Ger Med Sci) - "Prompt treatment with intravenous fluids, rasburicase, and febuxostat led to rapid resolution of TLS. Despite recovery, the patient died two weeks later from complications of advanced metastatic disease. This case highlights the need for early TLS recognition in high-risk CRC patients."

Journal • Acute Kidney Injury • Colorectal Cancer • Endocrine Disorders • Metabolic Disorders • Nephrology • Oncology • Renal Disease • Solid Tumor

Fulminant Mantle Cell Lymphoma Presenting With Hepatic Infiltration and Spontaneous Tumor Lysis Syndrome. (PubMed, Cureus) - "Given the presentation of spontaneous TLS, the patient was admitted to the intensive care unit for vasopressors, continuous renal replacement therapy, and rasburicase...Although hepatic MCL is rare, it can present with fulminant disease and spontaneous TLS. Timely recognition may expedite diagnosis and guide appropriate management, especially in elderly or frail patients where treatment must be individualized."

Journal • Acute Kidney Injury • Anorexia • B Cell Non-Hodgkin Lymphoma • Biliary Cancer • Cardiovascular • Cholestasis • Chronic Lymphocytic Leukemia • Coronary Artery Disease • Critical care • Gastroenterology • Geriatric Disorders • Hematological Disorders • Hematological Malignancies • Hepatology • Leukemia • Liver Failure • Lymphoma • Mantle Cell Lymphoma • Nephrology • Non-Hodgkin’s Lymphoma • Oncology • Pain • Palliative care • Solid Tumor • CD5 • FCER2 • MME

RISK OF TUMOR LYSIS SYNDROME AMONG PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA OR MANTLE CELL LYMPHOMA TREATED WITH VENETOCLAX: A REAL-WORLD STUDY (EHA 2026) - "TLS was identified using two definitions: (1) the presence of the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code E88.3 and (2) receipt of rasburicase treatment...Venetoclax was administered in combination with either rituximab or obinutuzumab in 44.3% and 40.7% of patients with CLL and MCL, respectively. Antihyperuricemic prophylaxis with either allopurinol or febuxostat at baseline was observed in 58.2% of patients with CLL and 63.7% of patients with MCL...The risk appeared to be relatively higher among patients with MCL than in those with CLL. These findings underscore the importance of close monitoring during venetoclax therapy, particularly during the dose ramp-up period."

Clinical • Real-world • Real-world evidence • B Cell Lymphoma • Chronic Lymphocytic Leukemia • Heart Failure • Leukemia • Lymphoma • Mantle Cell Lymphoma • Mood Disorders • Oncology • Renal Disease • BCL2

Low fixed dose rasburicase for tumour lysis syndrome prophylaxis and treatment is feasible and efficacious in the management of haematologic malignancies. (PubMed, J Oncol Pharm Pract) - "Despite rapid biochemical response, 47/99 (47%) of prophylaxis patients demonstrated LTLS and 14/99 (14%) developed CTLS, where 9/14 (64%) had pre-existing kidney impairment. Prescribing criteria compliance was 85%, with non-compliance primarily attributed to early biochemical changes or urgent need for anti-cancer therapy.ConclusionThis study confirmed the clinical and economic validity of low fixed-dose rasburicase for TLS prophylaxis in high- and intermediate-risk patients and TLS treatment, while demonstrating high compliance with institutional prescribing criteria."

Journal • Hematological Disorders • Hematological Malignancies • Oncology • Renal Disease

Hyperuricemia in preterm infants: clinical features and early rasburicase therapy. (PubMed, Pediatr Res) - "Hyperuricemia contributes to neonatal acute kidney injury (AKI) and is closely linked to prematurity and illness severity. Although rasburicase is established for malignancy-associated hyperuricemia, evidence in preterm infants remains limited. This is the first study to evaluate the efficacy and safety of early rasburicase in extremely preterm infants with hyperuricemia. Early rasburicase administration resulted in a rapid uric acid reduction of >90% and an association with favorable changes in renal parameters without observed adverse effects. Our findings provide novel evidence supporting rasburicase as a potential therapeutic option in neonatal intensive care to reduce hyperuricemia-related AKI risk."

Journal • Acute Kidney Injury • Critical care • Nephrology • Oncology • Renal Disease

Steroid-induced tumor lysis syndrome in solid tumors: A case report and review of the literature. (PubMed, Semin Oncol) - "He remained intubated due to airway edema and was started on dexamethasone...Despite IV hydration and rasburicase, he worsened and was transitioned to comfort care...A high index of suspicion is essential as early recognition and management of TLS are associated with improved outcomes. We encourage particular attention to be paid after steroids have been administered."

Journal • Cough • Hematological Disorders • Hematological Malignancies • Leukemia • Lung Cancer • Lymphoma • Oncology • Pain • Pulmonary Disease • Respiratory Diseases • Solid Tumor

THERAPEUTIC OUTCOMES IN ADULTS WITH BURKITT LYMPHOMA TREATED WITH THE LMB-02PROTOCOL: A SINGLE-CENTER EXPERIENCE (EHA 2026) - "Response was assessed after the initial COP course (cyclophosphamide, vincristine, and prednisolone) then after the first consolidation course and at the end of treatment...According to risk stratification, 11 (40.7%) patients were classified in group B and 16 (59.3%) in group C. Tumor lysis syndrome occurred in 12 patients (44.4%) following the COP course, and 14 patients (51.9%) received rasburicase...Seven patients (25.9%) received Rituximab during the induction courses...Early response assessment after the COP prephase appears useful for risk stratification. However, treatment-related mortality remains significant, particularly during induction and consolidation, and was observed exclusively in high-risk (group C) patients, highlighting the importance of optimized supportive care in this population."

Clinical • Burkitt Lymphoma • Hematological Malignancies • Lymphoma

Leukapheresis, rasburicase, and acute complications of hyperleukocytosis in pediatric leukemia: A retrospective cohort study. (PubMed, Transfus Apher Sci) - "In this retrospective cohort, leukapheresis effectively reduced the white blood cells but was not independently associated with a lower incidence of TLS or AKI.The higher crude mortality in the leukapheresis arm likely reflects baseline disease severity rather than a direct treatment effect."

Journal • Retrospective data • Acute Kidney Injury • Critical care • Endocrine Disorders • Hematological Malignancies • Leukemia • Nephrology • Oncology • Pediatrics • Renal Disease

Mapping metabolic reprogramming in lung and breast cancer through integrative bioinformatics. (PubMed, PLoS One) - "Integration of pharmacological evidence highlighted clinically actionable interactions between metabolic genes and FDA-approved drugs, including ASNS-asparaginase, DHODH-teriflunomide, and G6PD-rasburicase. This integrative analysis shows that cancer metabolism is altered in subtype-specific ways that can be systematically mapped to reveal potential therapeutic targets. By linking transcriptomic evidence with drug-gene interactions and clinical context, this framework provides a scalable approach for cancer metabolism research and supports the prioritization of pathways with potential translational relevance."

Journal • Breast Cancer • Lung Adenocarcinoma • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Solid Tumor • Squamous Cell Carcinoma • BRCA • SLC2A1

Real-world safety of rasburicase in patients with refractory chronic gouty arthritis：a retrospective observations study (EULAR 2026) - "Rasburicase (1.5–4.5 mg/dose) was administered every 4 weeks for up to three doses, with concomitant methotrexate to mitigate anti-drug antibody formation5. Conclusions Rasburicase exhibits a favorable safety profile in refractory gout, including those with baseline organ impairment. The absence of dose-dependent liver or kidney toxicity supports the flexible use of various cumulative regimens in complex gout populations."

Real-world • Real-world evidence • Retrospective data • Cardiovascular • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Dyslipidemia • Gout • Heart Failure • Hepatology • Hypertension • Immunology • Inflammatory Arthritis • Liver Failure • Metabolic Disorders • Nephrology • Renal Disease • Rheumatology