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Predictors of antiemetic alteration in pediatric acute myeloid leukemia
Author(s) -
Freedman Jason L.,
Faerber Jennifer,
Kang Tammy I.,
Dai Dingwei,
Fisher Brian T.,
Huang YuanShung,
Li Yimei,
Aplenc Richard,
Feudtner Chris
Publication year - 2014
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25108
Subject(s) - medicine , myeloid leukemia , antiemetic , myeloid , leukemia , oncology , intensive care medicine , chemotherapy
Background Better knowledge of patient and cancer treatment factors associated with nausea/vomiting (NV) in pediatric oncology patients could enhance prophylaxis. We aimed to describe such factors in children receiving treatment for acute myeloid leukemia (AML). Methods Retrospective longitudinal cohort study of 1,668 hospitalized children undergoing treatment for AML from the Pediatric Health Information System database (39 hospitals, 1999–2010). Antiemetic alteration, which included switch (a change in prescribed 5‐HT 3 receptor antagonists) and rescue (receipt of an adjunct antiemetic), were first validated and then used as surrogates of problematic NV. Logistic and negative binomial regression modeling were used to test whether patient characteristics were associated with problematic NV. Results Increasing age is associated with greater odds of experiencing antiemetic switch and higher relative rate of antiemetic rescue. Within a treatment cycle, each consecutive inpatient chemotherapy day decreased the likelihood of requiring antiemetic alteration. Each consecutive inpatient‐day post‐chemotherapy was associated with decreased need for switch, but increased need for rescue. Subsequent cycles of AML therapy were associated with lower odds of antiemetic switch on both chemotherapy and non‐chemotherapy days, a lower rate of antiemetic rescue on chemotherapy days, and an increased rate of rescue on non‐chemotherapy days. Conclusion In pediatric patients with AML, increasing age is strongly associated with greater antiemetic alteration. Antiemetic alteration occurs early in treatment overall, and early within each admission. While additional cycles of therapy are associated with less alteration overall, there is persistent rescue in the days after chemotherapy, suggesting additional etiologies of NV in pediatric cancer patients. Pediatr Blood Cancer 2014; 61:1798–1805. © 2014 Wiley Periodicals, Inc.