[Analysis and protocolization of rasburicase use in patients with hematologic neoplasms]. / Análisis y protocolización de la utilización de rasburicasa en pacientes con neoplasias hematológicas.

OBJECTIVE: To describe the use of rasburicase in adult patients with hematological neoplasias and to present a protocol for its administration jointly prepared by the hematology and the pharmacy departments based on the scientific evidence available. METHOD: Retrospective study that reviews treatments with rasburicase administered in a tertiary 800-bed hospital from July 2002 to May 2004 to adult patients with hematological neoplasias. The following data were collected: demographic and clinical data, daily dose of rasburicase and length of treatment, plasma levels of creatinine, potassium, phosphate, calcium, LDH, uric acid and white blood cell count daily and until 48 hours after administering the last dose of rasburicase. RESULTS: Rasburicase was administered to a total of 18 adult patients (mean age of 57 years; range 27-84; 11 men and 7 women). Prior to treatment, 16 patient had high levels of LDH, 12 patients had a blood count over 50,000 white blood cells/mm3, and 11 had serum levels of uric acid above 7 mg/dl. The dose of rasburicase administered was 0.2 mg/kg/day and the median length of treatment was 5 days (range 1-10). The levels of uric acid returned to normal values in all patients. Furthermore, an statistically significant decrease of creatinine levels was observed. The other biochemical parameters studied were duly controlled throughout the treatment. CONCLUSIONS: A high variability is observed in the use of rasburicase in our patients. The hematology and pharmacy services have been working jointly to prepare a consensus-based protocol according to which, depending on the patient s risk of developing TLS (tumoral lysis syndrome), standard prophylaxis is administered to low-risk patients (intravenous hydration, alopurinol and urine alcalinization) and rasburicase is administered initially for 1-3 days to patients with high risk of developing TLS.

Análisis y protocolización de la utilización de rasburicasa en pacientes con neoplasias hematológicas / Analysis and protocolization of rasburicase use in patients with hematologic neoplasms

Objetivo: Describir la utilización de rasburicasa en pacientes adultos con neoplasias hematológicas y presentar un protocolo de su utilización elaborado conjuntamente por los servicios de hematología y farmacia, basándonos en la evidencia científica disponible. Método: Estudio retrospectivo que analiza los tratamientos con rasburicasa administrados en un hospital terciario de 800 camas entre julio 2002 y noviembre 2004 a pacientes adultos con neoplasias hematológicas. De cada paciente se recogieron: datos demográficos y clínicos, dosis diaria de rasburicasa y duración de tratamiento, concentraciones séricas de creatinina, potasio, fosfato, calcio, LDH, ácido úrico y recuento de leucocitos diariamente, y hasta 48 horas después de la última administración de rasburicasa. Resultados: Rasburicasa se administró en un total de 18 pacientes adultos (edad media 57 años, rango 27-84, 11 hombres y 7 mujeres). De manera previa al tratamiento, 16 pacientes presentaban una LDH sérica ≥ 3 veces el límite superior de la normalidad, 12 pacientes un recuento de más de 50.000 leucocitos/mm3, y 11 pacientes una concentración sérica de ácido úrico superior a 7 mg/dl. La dosis de rasburicasa empleada fue 0,2 mg/kg/día y la mediana de duración de tratamiento fue de 5 días (rango 1-10). En todos los pacientes se normalizaron los niveles de ácido úrico. Además, los niveles de creatinina descendieron de un modo estadísticamente significativo. El resto de parámetros bioquímicos estudiados se controlaron adecuadamente a lo largo del tratamiento. Conclusiones: Se observa una elevada variabilidad en el uso de rasburicasa en nuestros pacientes. Los servicios de hematología y farmacia hemos trabajado conjuntamente consensuando un protocolo de utilización en el que atendiendo al riesgo de los pacientes de desarrollar SLT (síndrome de lisis tumoral) se administra profilaxis estándar (hidratación intravenosa, alopurinol y alcalinización de la orina) en aquellos pacientes con bajo riesgo y se administra rasburicasa inicialmente durante 1-3 días en los pacientes con alto riesgo de desarrollar SLT

Objective: To describe the use of rasburicase in adult patients with hematological neoplasias and to present a protocol for its administration jointly prepared by the hematology and the pharmacy departments based on the scientific evidence available. Method: Retrospective study that reviews treatments with rasburicaseadministered in a tertiary 800-bed hospital from July 2002 to May 2004 to adult patients with hematological neoplasias.The following data were collected: demographic and clinical data, daily dose of rasburicase and length of treatment, plasma levels of creatinine, potassium, phosphate, calcium, LDH, uricacid and white blood cell count daily and until 48 hours after administering the last dose of rasburicase. Results: Rasburicase was administered to a total of 18 adult patients (mean age of 57 years; range 27-84; 11 men and 7 women). Prior to treatment, 16 patient had high levels of LDH, 12 patients had a blood count over 50,000 white bloodcells/mm3, and 11 had serum levels of uric acid above 7 mg/dl. The dose of rasburicase administered was 0.2 mg/kg/day and the median length of treatment was 5 days (range 1-10). The levels of uric acid returned to normal values in all patients. Furthermore, an statistically significant decrease of creatinine levels was observed. The other biochemical parameters studied were duly controlled throughout the treatment. Conclusions: A high variability is observed in the use of rasburicase in our patients. The hematology and pharmacy services have been working jointly to prepare a consensus-based protocol according to which, depending on the patient´s risk of developing TLS (tumoral lysis syndrome), standard prophylaxis is administered to low-risk patients (intravenous hydration, alopurinol andurine alcalinization) and rasburicase is administered initially for 1-3 days to patients with high risk of developing TLS

Familial hairy cell leukemia: a HLA-linked disease or farmers-linked disease?

In the 16 cases of familial HCL published, different HLA have been found. Although specific HLA antigens were found to have the same structure in some cases that suggests a genetic predisposition to HCL. Environmental factors, specifically farming labours, were implicated in too. We add two cases (father and son, both farmers), Their HLA haplotype has not been described, but the type A2Bw4Bw6 and Bw6, presented in father and/or son, have been.