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Olanzapine for treatment and prevention of acute chemotherapy‐induced vomiting in children: A retrospective, multi‐center review
Author(s) -
Flank Jacqueline,
Thackray Jennifer,
Nielson Danelle,
August Amanda,
Schechter Tal,
Alexander Sarah,
Sung Lillian,
Dupuis L. Lee
Publication year - 2015
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.25286
Subject(s) - olanzapine , medicine , vomiting , anesthesia , antiemetic , adverse effect , chemotherapy , chemotherapy induced nausea and vomiting , dopamine antagonist , nausea , retrospective cohort study , pediatrics , antagonist , psychiatry , schizophrenia (object oriented programming) , receptor
Background This retrospective review provides preliminary data regarding the safety and efficacy of olanzapine for chemotherapy‐induced vomiting (CIV) control in children. Procedure Children <18 years old who received olanzapine for acute chemotherapy‐induced nausea and vomiting (CINV) control from December 2010 to August 2013 at four institutions were identified. Patient characteristics, chemotherapy, antiemetic prophylaxis, olanzapine dosing, CIV control, liver function test results and adverse events were abstracted from the health record. Toxicity was graded using CTCAEv4.03. Results Sixty children (median age 13.2 years; range: 3.10–17.96) received olanzapine during 158 chemotherapy blocks. Olanzapine was most often (59%) initiated due to a history of poorly controlled CINV. The mean initial olanzapine dose was 0.1 mg/kg/dose (range: 0.026–0.256). Most children who received olanzapine beginning on the first day of the chemotherapy block experienced complete CIV control throughout the acute phase (83/128; 65%). There was no association between the olanzapine dose/kg and complete CIV control (OR 1.01; 95% CI: 0.999–1.020; P = 0.091). Sedation was reported in 7% of chemotherapy blocks and was significantly associated with increasing olanzapine dose (OR: 1.17; 95% CI: 1.08–1.27; P = 0.0001). Of the 25 chemotherapy blocks where ALT and/or AST were reported more than once, grade 1–3 elevations were observed in five. The mean weight change in 31 children who received olanzapine during more than one chemotherapy block was 0% (range: −22 to +18). Conclusion Olanzapine may be an important option to improve CIV control in children. Prospective controlled evaluation of olanzapine for CINV prophylaxis in children is warranted. Pediatr Blood Cancer 2015;62:496–501. © 2014 Wiley Periodicals, Inc.