Elitek (rasburicase) / Sanofi - LARVOL DELTA

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

Acute Hemolytic Anemia Following Rasburicase in a Very Late Post-Transplant Relapse of Acute Myeloid Leukemia. (PubMed, Mediterr J Hematol Infect Dis) - No abstract available

Journal • Acute Myelogenous Leukemia • Anemia • Hematological Disorders • Hematological Malignancies • Leukemia • Oncology • Transplantation

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

Concurrent tumor lysis syndrome and 5-fluorouracil encephalopathy during the first cycle of zolbetuximab plus mFOLFOX6 for CLDN18.2-positive gastric cancer: a case report. (PubMed, Int Cancer Conf J) - "Discontinuation of 5-FU and supportive care consisting of hydration and rasburicase led to rapid clinical improvement. Chemotherapy, which was resumed after a dosage adjustment, achieved tumor shrinkage and resolved the hydronephrosis. To the best of our knowledge, the present study is the first to describe concurrent TLS and 5-FU-induced encephalopathy during the administration of a zolbetuximab-based regimen and highlights the need for proactive prophylaxis against TLS and for controlling nausea in AGC patients with a high tumor burden, baseline renal impairment, and cachexia."

Journal • Cachexia • CNS Disorders • Gastric Cancer • Nephrology • Oncology • Peritoneal Cancer • Renal Disease • Solid Tumor • CLDN18 • HER-2

Continuous hemodiafiltration during chemotherapy for acute kidney injury in spontaneous tumor lysis syndrome due to high-grade B-cell lymphoma: a case report. (PubMed, CEN Case Rep) - "Rasburicase was given once on hospital day 12...Switching to CHDF to sustainably correct hyperuricemia and electrolyte abnormalities resulted in favorable renal outcomes without complications. Although evidence regarding the efficacy of CHDF against TLS-induced AKI remains very limited, we suggest that management with CHDF for AKI in STLS or TLS is reasonable to prevent TLS aggravation during chemotherapy and to avert renal toxicity from the chemotherapy itself."

Journal • Acute Kidney Injury • B Cell Lymphoma • Fatigue • Hematological Disorders • Hematological Malignancies • High-grade B-cell lymphoma • Lymphoma • Metabolic Disorders • Nephrology • Non-Hodgkin’s Lymphoma • Oncology • Renal Disease

Research progress on multidimensional intervention strategies for hyperuricemia: Western medicine, Traditional Chinese Medicine, and emerging therapies. (PubMed, Front Endocrinol (Lausanne)) - "This article systematically reviews the current various intervention methods and research status for the treatment of hyperuricemia: In the field of Western medicine, it deeply analyzes the efficacy, mechanism of action, and clinical limitations of drugs that promote uric acid excretion (such as benzbromarone and dotinurad), drugs that inhibit uric acid synthesis (such as allopurinol, febuxostat, and topiroxostat), and drugs that promote uric acid hydrolysis (such as pegloticase and rasburicase). It focuses on elaborating the research breakthroughs of URAT1 inhibitor derivatives and the new drug SHR4640...At the same time, it details the action pathways and clinical evidence of emerging therapies such as SGLT2 inhibitors, the GLP-1/GCG dual-receptor agonist Mazdutide, probiotics, and washed microbiota transplantation (WMT). By summarizing mechanistic insights, clinical progress, and translational prospects, this review aims to inform the development of individualized and..."

Journal • Review • Cardiovascular • Gout • Inflammatory Arthritis • Metabolic Disorders • Rheumatology • Transplantation • GCG

Not Available (PubMed, AMB Express) - "Comparative molecular dynamics simulations with rasburicase indicated that, based on RMSF, radius of gyration (Rg), and hydrogen-bond counts, TC1-Uox2 adopts a more compact overall structure...These findings elucidate the structural basis of its enhanced thermostability. In summary, TC1-Uox2 is a high-activity, high-stability uricase candidate that represents a promising enzyme target for biotherapeutic intervention in hyperuricemia and illustrates the translational potential of extreme-environment metagenomics for metabolic disease applications."

Journal • Gout • Inflammatory Arthritis • Metabolic Disorders • Rheumatology

The Use of Single Dose of Rasburicase for the Prophylaxis and Treatment of Tumor Lysis Syndrome in Pediatric Patients: A Narrative Review. (PubMed, Hematol Rep) - " Single dose of rasburicase for the prophylaxis and treatment of TLS in pediatric oncology is an appealing approach with potentially less financial impact and drug toxicity. A fixed dose of at least 3 mg or 0.15 mg/kg by body weight is recommended."

Journal • Review • Acute Lymphocytic Leukemia • Burkitt Lymphoma • Hematological Malignancies • Leukemia • Lymphoma • Oncology • Pediatrics

Pegloticase for the Reduction of Uric Acid in Patients With Tumor Lysis Syndrome (clinicaltrials.gov) - P4 | N=10 | Active, not recruiting | Sponsor: M.D. Anderson Cancer Center | Trial completion date: Dec 2025 ➔ Jul 2026 | Trial primary completion date: Dec 2025 ➔ Jul 2026

Trial completion date • Trial primary completion date • Hematological Malignancies • Oncology • Solid Tumor

Efficacy of 3 mg Versus 6 mg Rasburicase in the Prevention of Tumor Lysis Syndrome (ASHP 2025) - No abstract available

Clinical • Oncology

Evaluation of Rasburicase Use at a Large Academic Medical Center (ASHP 2025) - No abstract available

Rasburicase Prescribing Patterns Pre- and Post-guideline Implementation (ASHP 2025) - No abstract available

Impact of Early Allopurinol on Renal Function and Rasburicase Utilization in Patients with Diffuse Large B-cell Lymphoma or High-grade B-cell Lymphoma (ASHP 2025) - No abstract available

Clinical • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • High-grade B-cell lymphoma • Lymphoma • Non-Hodgkin’s Lymphoma

Retrospective Review of Flat-Dosing Versus Weight-Based Dosing Rasburicase in Managing Tumor Lysis Syndrome-related Hyperuricemia (ASHP 2025) - No abstract available

Retrospective data • Review • Oncology

Retrospective Evaluation of Fixed-Dose Rasburicase (3 mg vs. 6 mg) for Uric Acid Normalization in Tumor Lysis Syndrome (ASHP 2025) - No abstract available

Retrospective data • Oncology

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