Study links early rasburicase to fewer cases of dialysis or death

When tumor lysis syndrome strikes, a cancer patient's kidneys can be pushed into failure by the debris released as large numbers of tumor cells break down. In a multicenter analysis, adults given rasburicase within 12 hours of developing the syndrome were about one-third less likely to need dialysis or die during their hospital stay than patients treated later or not at all.

The study followed 1,276 adults treated at 36 U.S. hospitals between 2014 and 2023. The team was led by David Leaf, MD, of Mass General Brigham; the research, published in the BMJ, used an emulated target trial, a design that applies real-world data to approximate a randomized clinical trial.

The biology is direct. Rapid tumor-cell breakdown releases substances including uric acid into the bloodstream, and uric acid can damage the kidneys. Rasburicase rapidly lowers uric acid levels; the drug has already been widely used for TLS for more than two decades.

The researchers estimated that early treatment would prevent one case of dialysis or death per 11 patients treated. Early rasburicase was also associated with lower 90-day mortality and a faster return to cancer therapy, with the greatest benefit among patients who were already the sickest, including those with moderate-to-severe kidney injury when TLS developed.

So what changes in practice? The findings give cancer teams a clearer outcome-based reason to act quickly when TLS appears, especially when kidney injury is already present. They remain an association from an emulated trial rather than evidence from a randomized clinical trial, so the results support prompt treatment without removing the need for clinical judgment.