Tumour lysis syndrome (TLS) can be caused by some chemotherapy drugs. Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. As the cancer cells break down, they release a chemical called uric acid, which is removed from the body by the kidneys.
TLS can happen when lots of cancer cells are destroyed very quickly. The kidneys cannot cope with the increased amount of uric acid. This leads to imbalances in some chemicals (phosphate, potassium and calcium) in the blood. These imbalances can cause more serious problems affecting the kidneys and the heart.
TLS is more common in cancers that grow quickly and respond quickly to chemotherapy, such as acute leukaemias and high-grade lymphomas. People with other types of cancer are rarely affected by TLS.
Rasburicase is given before or with your first chemotherapy treatment.
Your nurse will give you rasburicase through one of the following:
- a short, thin tube (cannula) that the nurse puts into a vein in your arm or hand
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you rasburicase as a drip into your vein. The infusion is given over 30 minutes. You may have one dose or a daily dose for up to 7 days. Your doctors will decide how many days of treatment you need. They will do this by taking regular blood tests to check the level of uric acid in your blood.
They will also give you large amounts of fluids through a line into your bloodstream to help flush through your kidneys. This is called intravenous hydration. This means you pass more urine (pee) than usual.
Each person’s reaction to any medication is different. Most people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is having rasburicase.
You may also have side effects from the cancer drugs you are given. If you notice any side effects that are not listed here, discuss them with your nurse or doctor.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Before you have rasburicase
It is important to tell your doctor if you:
- have ever had haemolytic anaemia (an illness caused by red blood cells being abnormally broken down)
- have the metabolic disorder Glucose-6-phosphate dehydrogenase (G6PD) deficiency, which can cause haemolytic anaemia.
Rasburicase is not suitable for people who have G6PD deficiency or similar disorders that can cause haemolytic anaemia.
Your nurse will monitor your temperature during treatment. Signs of a high temperature can include feeling hot and sweaty or cold and shivery. It is important to let the nurse or doctor know if you feel you have a high temperature.
Rarely, rasburicase may cause an allergic reaction while it is being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of an allergic reaction can include:
- a rash
- feeling itchy
- feeling short of breath
- chest pain.
Tell your nurse straight away if you have any of these symptoms.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
Feeling sick (nausea)
You may feel sick or be sick (vomit) during treatment with rasburicase. Your doctor can prescribe anti-sickness drugs (anti-emetics) to help.
Take the drugs exactly as your nurse or pharmacist tells you to. If you are sick after taking rasburicase, contact the hospital for advice.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Rarely, rasburicase can increase the breakdown of red blood cells. You will have regular blood tests during your treatment to check for this.
It is important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they are not mentioned above.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
Some medicines can be harmful to take when you are having cancer treatment.
Tell your doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies. This includes medicines and supplements you can buy in a shop or chemist.
Pregnancy and breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Women are also advised not to breastfeed when taking this treatment. This is because the medicine may be passed to the baby through the breast milk.