A 60-year-old man starting induction chemotherapy for Burkitt lymphoma has uric acid 11 mg/dL, potassium 5.4 mEq/L, phosphate 6.2 mg/dL, and LDH 1400 U/L before the first dose. Which prophylactic agent is preferred in this setting?
- A Allopurinol started 24 hours after chemotherapy
- B Febuxostat alone without hydration
- C Rasburicase with aggressive IV hydration ✓
- D Sodium bicarbonate alkalinisation alone
Correct answer: C. Rasburicase with aggressive IV hydration
Explanation
Burkitt lymphoma is among the highest-risk tumours for tumour lysis syndrome because of high proliferative rate and bulky chemo-sensitive disease. With established hyperuricaemia plus other electrolyte abnormalities before therapy, rasburicase, a recombinant urate oxidase that converts uric acid to soluble allantoin, is preferred over allopurinol, which only prevents new urate formation. Alkalinisation promotes calcium phosphate deposition and is no longer recommended. Prophylaxis must begin before chemotherapy, not after.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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