Safety and efficacy of a continuous infusion, patient controlled antiemetic pump to facilitate outpatient administration of high-dose chemotherapy

We evaluated the combination of diphenhydramine, lorazepam, and dexamethaso ne delivered as a continuous i.v. infusion via an ambulatory infusion pump with patient-activated intermittent dosing (BAD pump) for prevention of acu te and delayed nausea/vomiting in patients receiving high-dose chemotherapy (HDC) for peripheral blood progenitor cell (PBPC) mobilization (MOB) or pr ior to autologous PBPC rescue. The BAD pump was titrated to patient respons e and tolerance, and continued until the patient could tolerate oral antiem etics, Forty-four patients utilized the BAD pump during 66 chemotherapy cou rses, 34 (52%) for MOB and 32 ( 48%) for HDC with autologous PBPC rescue. T he median number of days on the BAD pump during MOB and HDC was 3 (1-6) and 9 (2-19) days, respectively. Complete overall or complete emesis control o ccurred on 94% of MOB and 89% of HDC treatment days during chemotherapy adm inistration and 72% and 43%, respectively, following chemotherapy administr ation. Eighty-three percent of MOB and 55% of HDC treatment days were assoc iated with no nausea. While on the BAD pump, no patient experienced severe toxicity or required hospitalization for management of nausea/vomiting. The BAD pump was safe and effective in minimizing nausea and vomiting associat ed with HDC, and thus, eliminated the need for hospitalization for manageme nt of chemotherapy-induced nausea and vomiting.