Use of allopurinol in preventing hyperuricemia in leukemia and lymphoma

Abstract

The treatment of leukemia and lymphoma with cytotoxic agents often leads to the overproduction of uric acid due to the rapid breakdown of cellular nucleic acids. This may result in precipitation of uric acid in the urinary tract with severe, sometimes fatal, urinary obstruction. The methods previously available to prevent or treat this complication have not always been adequate. Allopurinol [4–hydroxypyrazolo (3,4–d) pyrimidine] is an inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine and xanthine to uric acid. In man it causes marked inhibition of uric acid production with a decrease in serum and urine uric acid. It has been used in 75 patients with leukemia or lymphoma treated with cytotoxic agents and has consistently prevented or reversed hyperuricemia. No uric acid nephropathy has occurred in this group of patients and allopurinol has caused no significant toxicity. The accumulation of the oxypurines, hypoxanthine and xanthine has been much smaller than the decrease in production of uric acid and no evidence of urinary precipitation of these oxypurines has been seen. The author concludes that allopurinol is an effective and useful agent in reducing the hazard of uric acid nephropathy in patients with leukemias and lymphomas in whom rapid lysis of cells may be expected as a result of therapy. Copyright © 1966 American Cancer Society