Side Effect: Increase in Uric Acid in Blood (Hyperuricemia)

• Hyperuricemia is a medical condition characterized by increased uric acid in the blood
• Uric acid is formed from a natural process during the breakdown of DNA released by white blood cells when they die.
• Hyperuricemia can result from either producing too much or getting rid of too little uric acid
• Normally, uric acid in the blood is filtered by the kidneys and eliminated in the urine. If the kidneys are not working as well, this can lead to a build up of uric acid in the body

• Hyperuricemia itself does not usually cause any symptoms, but it is detected through a blood test.
• It can lead to the development of other medical conditions that present with their own symptoms.
  • For example, hyperuricemia leads to the formation of crystals called urate crystals. These can accumulate in joints, and cause swelling and pain leading to a condition called gout.
  • In more severe cases, the crystals deposit in the kidneys, causing formation of kidney stones. This can represent as lower back pain, and in certain patients with leukemia or lymphoma, may even cause kidney failure

• In patients with cancer, the risk of hyperuricemia risk can often be predicted based upon the type of cancer treatment.
• Certain blood cancers, such as leukemias or lymphomas, put patients at higher risk because they can cause tumor lysis syndrome, or TLS.
  • A common signs of TLS includes a high uric acid level in the bloodstream
  • Additionally, chemotherapy may lead to increased uric acid in the blood as cancer cells die and release their contents into the bloodstream.

• The key to preventing an increase in uric acid is hydration. While receiving cancer treatment, providers may recommend intravenous (I.V.) hydration to dilute the uric acid in the blood and allow the kidney to filter it before it builds up to dangerous levels.
• A medication known as allopurinol works by preventing the formation of uric acid, and is commonly given when patients start their first treatment for leukemia or lymphoma.
  • Importantly, not all patients with leukemia or lymphoma require allopurinol when starting chemotherapy.

Treatment involves medications that help reduce uric acid levels.

Examples:

• Allopurinol [Zyloprim®] oral pill taken daily
• Febuxostat [Uloric®] oral pill taken daily
• Rasburicase [Elitek®] intravenous, usually given as a single dose
• Intravenous fluids = to flush out uric acid
• Dialysis = used in more severe cases to remove uric acid quickly from the blood.

It is important to discuss the specific treatment approach with the healthcare team, as each patient with cancer’s case will be different and depend on the underlying cause of hyperuricemia.