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Revised antiemetics guidelines and the impact on nutritional status during induction chemotherapy in children with high‐risk neuroblastoma
Author(s) -
Carroll Catherine,
Clinton Frieda,
Smith Aisling,
Fox Aine,
Capra Michael,
Pears Jane,
Owens Cormac
Publication year - 2018
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.27386
Subject(s) - medicine , chemotherapy , antiemetic , induction chemotherapy , ondansetron , group b , retrospective cohort study , pediatrics , neuroblastoma , guideline , neutropenia , vomiting , pathology , biology , genetics , cell culture
Background High‐risk neuroblastoma (HR NBL) treatment requires intensive induction chemotherapy. The profoundly emetogenic agents used can compromise nutritional status. Our institution introduced a new antiemetic guideline in 2010 incorporating regular dexamethasone, in addition to ondansetron, for all highly emetogenic protocols. Procedure A retrospective comparative review of pediatric patients diagnosed with HR NBL who received rapid COJEC induction chemotherapy as per HR‐SIOPEN NBL trial. Prophylactic antiemetics were prescribed regardless of chemotherapy emetogenicity in group A (2004–2010) but for defined time periods considering chemotherapy emetogenicity in group B (2010–2017). Results Sixty‐three children were eligible for inclusion (median age, 31 months; range, 1–88 months). Group A had more episodes of emesis than group B (189 vs. 116, P < 0.0001). There was a significant difference in weight‐for‐age Z score change between the groups by induction end ( P = 0.0027). Four children (13%) in group A lost >10% body weight versus none in group B. Nutrition support (NS) was utilized by 29 children (94%) in group A and 22 children (69%) in group B. Group A had a median of 3 (range, 1–7) admissions for febrile neutropenia (FN) versus a median of 1.5 (range, 0–4) for group B ( P = 0.003) during induction. Conclusion The review of our guidelines led to reduced emesis frequency for group B. They also required less NS, followed expected growth trajectories more closely and had fewer FN admissions. We propose that this may have occurred due to better emesis control resulting in improved nutritional status and associated enhanced immune function.