Korean J Intern Med.  2015 Jul;30(4):521-530. 10.3904/kjim.2015.30.4.521.

Allopurinol hypersensitivity syndrome in patients with hematological malignancies: characteristics and clinical outcomes

• Min HK
• Lee B
• Kwok SK
• Ju JH
• Kim WU
• Park YM
• Park SH

• KMID: 2366013
• DOI: http://doi.org/10.3904/kjim.2015.30.4.521

Abstract

BACKGROUND/AIMS
Allopurinol is a urate-lowering agent that is commonly used to prevent chemotherapy-related hyperuricemia. Allopurinol hypersensitivity syndrome (AHS) is a disorder involving multiple organs, which may be accompanied by cutaneous adverse reactions. We identified the characteristics and clinical outcomes of chemotherapy-associated AHS in patients with hematological malignancies.
METHODS
This retrospective single-center study included 26 AHS patients (11 with and 15 without hematological malignancies) admitted to Seoul St. Mary's Hospital. AHS was defined using the criteria of Singer and Wallace. Comparisons were made using the Mann-Whitney U test and Fisher exact test as appropriate.
RESULTS
In patients with a hematological malignancy and AHS, statistically significant differences were observed in terms of younger age at onset; shorter duration of exposure; higher starting and maintenance doses of allopurinol; lower incidence of eosinophilia, leukocytosis, and underlying renal insufficiency; and more frequent occurrence of fever compared to AHS patients without a hematological malignancy. Two AHS patients with a hematological malignancy were examined for human leukocyte antigen (HLA)-B typing, but neither patient harbored the HLA-B*5801 allele. All of the patients ceased allopurinol treatment, with most patients making a full recovery. Two patients in the study died; however, these deaths were unrelated to AHS. One patient developed serious sequelae of AHS that required hemodialysis.
CONCLUSIONS
Physicians who prescribe allopurinol for the prevention of chemotherapy-related hyperuricemia should be aware of the unique risk of AHS, even in patients with hematological malignancies who do not have known risk factors for AHS. Novel urate-lowering agents should be considered alternative treatments.

Keyword

Allopurinol hypersensitivity syndrome; Hematologic neoplasms

MeSH Terms

Adolescent
Adult
Age Factors
Aged
Allopurinol/*adverse effects
Antineoplastic Agents/*adverse effects
Comorbidity
Dose-Response Relationship, Drug
Drug Hypersensitivity Syndrome/diagnosis/drug therapy/*etiology
Female
Glucocorticoids/therapeutic use
Gout Suppressants/*adverse effects
Hematologic Neoplasms/*drug therapy
Humans
Hyperuricemia/chemically induced/diagnosis/*prevention & control
Male
Medical Records
Middle Aged
Republic of Korea
Retrospective Studies
Risk Factors
Treatment Outcome
Young Adult
Allopurinol
Antineoplastic Agents
Glucocorticoids
Gout Suppressants