Mt. Holdsworth et al., ASSESSMENT OF CHEMOTHERAPY-INDUCED EMESIS AND EVALUATION OF A REDUCED-DOSE INTRAVENOUS ONDANSETRON REGIMEN IN PEDIATRIC OUTPATIENTS WITH LEUKEMIA, The Annals of pharmacotherapy, 29(1), 1995, pp. 16-21
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.