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Background: Efficacy of rasburicase in pediatric patients with leukemia and lymphoma is proved. This study aims to
weigh efficacy and safety of rasburicase versus more conventional therapy, allopurinol, and to compare their safety
and properties in tumor lysis syndrome (TLS) of leukemia and lymphoma patients.
Materials and Methods: The study was done with a retrospective cohort design. Patients were selected from our
hematology ward admitted from 2005 through 2008. Patients were put into two groups based on their blood levels
of uric acid, before initiation of chemotherapy treatment group (the Uric Acid level of 6.5 mg/dl or more) and the
prophylaxis group (the uric acid level below 6.5 mg/dl). Evaluation of effectiveness of therapy was performed after
24, 48, 72-hour, and longer periods.
Results: Of 184 patients 69% had leukemia, and 31% lymphoma. Twenty patients were treated with rasburicase
and 164 with allopurinol. Mean age of patients was 7.93± 4.247 years old. 60.8% were male and 39.2% were female.
According to Chi-square test results, there was no significant difference between two agents regarding prophylaxis
(chi-square = 4.247, p-value = 0.193) and treatment (chi-square = 0.780, p-value = 0.677). Most of the response to
each agent was seen in the first 24 hours after drug administration. Mean level of uric acid reduced from 7.4 to 3.4
mg/dl in rasburicase, and from 5.4 to 3.9 mg/dl in allopurinol group. Mean duration of treatment for rasburicase was
2 days, and for allopurinol 6 days. Adverse effects were minimal in both groups (in rasburicase 1.6% and in allopurinol
5.4%).
Conclusion: Rasburicase seems to be highly efficient in both prophylaxis and treatment of Hyperuricemia. Due to
high costs in our practice, it was only administered to 20 patients with high levels of blood uric acid or leukocytosis.
It prepares patients for chemotherapy faster and decreases cost of hospital stay indirectly by lowering cost of
treatment. Allopurinol, alternatively showed equal efficiency and comparable results. Thus, it can be used safely and
effectively until rasburicase becomes more widely available and more cost-effective.

Keywords: Hyperuricemia, Rasburicase, Allopurinol, Leukemia, Lymphoma

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