ASSESSMENT OF CHEMOTHERAPY-INDUCED EMESIS AND EVALUATION OF A REDUCED-DOSE INTRAVENOUS ONDANSETRON REGIMEN IN PEDIATRIC OUTPATIENTS WITH LEUKEMIA

OBJECTIVE: TO measure the severity of nausea and vomiting in pediatric patients receiving intravenous or intrathecal chemotherapy for acute lymphoblastic leukemia and to evaluate the effectiveness of 2 intraven ous doses of ondansetron for this condition. DESIGN: Patients were sur veyed during repeated treatments of maintenance chemotherapy, given wi th or without ondansetron, using a repeated measures pretest/posttest design. SETTING: Outpatient pediatric oncology clinic. PATIENT POPULAT ION: Sixteen pediatric patients (aged 2-15 years, mean 6.2) with acute lymphoblastic leukemia. METHODS: Surveys to assess nausea and vomitin g and the extent of interference with daily activities were administer ed following emetogenic chemotherapy with or without ondansetron. RESU LTS: A total of 255 surveys following emetogenic chemotherapy with dau norubicin, cyclophosphamide, carmustine, and etoposide and cytarabine combined, as well as intrathecal therapy with methotrexate, hydrocorti sone, and cytarabine, were analyzed. Analysis was performed on surveys of 149 courses without antiemetic therapy and 106 courses after 2 dos es of ondansetron 0.15 mg/kg iv. The most emetogenic chemotherapy trea tment was the etoposide/cytarabine combination (p<0.05). Ondansetron c ompletely protected patients (defined as no nausea or no vomiting) dur ing most (>50%) of the chemotherapy treatments, except for those in wh ich cyclophosphamide was used. Ondansetron provided greater control of nausea and vomiting, a higher percentage of complete protection, and decreased the daily activity interference rating for carmustine and et oposide/cytarabine compared with courses of chemotherapy without antie metics (p<0.05). Two intravenous doses of ondansetron also provided du rable antiemetic efficacy over time for the most emetogenic chemothera py treatment (etoposide/cytarabine). CONCLUSIONS: Etoposide/cytarabine proved to be the most emetogenic of the chemotherapy treatments studi ed. A reduced-dose regimen of intravenous ondansetron was shown to be an effective antiemetic for the outpatient treatments with etoposide/c ytarabine and carmustine, but not with cyclophosphamide.