Low fixed dose rasburicase for tumour lysis syndrome prophylaxis and treatment is feasible and efficacious in the management of haematologic malignancies

IntroductionRasburicase is a high-cost medicine indicated for the prevention and treatment of tumour lysis syndrome (TLS). Growing evidence supports low fixed-dose rasburicase regimens (3-6 mg), however, uncertainty remains regarding their ability to prevent progression to clinical TLS, particularly in high-risk populations. Some institutions implement medicine governance strategies, such as a medicines formulary, to optimise safe, effective, and economical use through specific criteria, risk stratification and dosing stipulations, to facilitate appropriate prescribing. This study aimed to evaluate biochemical TLS (BTLS) and clinical TLS (CTLS) outcomes with rasburicase and characterise compliance with institutional prescribing criteria.MethodsA retrospective, single-centre, observational study was conducted of adults with haematologic malignancies who received at least one dose of rasburicase between March 2017 and March 2025. Rasburicase indication, dosing, TLS outcomes, and compliance with prescribing criteria were analysed.ResultsOut of the 144 patients, 114/144 (79%) were high-risk for TLS and 99/144 (69%) received rasburicase prophylactically. Fixed low-doses predominated, with 61% receiving a single dose. Urate normalisation within 24 h occurred in 92% of all patients and 97% of prophylaxis patients. 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.