Conflict of interest: B.T.F. receives research funding from Pfizer Pharmaceuticals. This funding is paid directly to the institution and not to the author.
Predictors of antiemetic alteration in pediatric acute myeloid leukemia
Version of Record online: 17 JUN 2014
© 2014 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 61, Issue 10, pages 1798–1805, October 2014
How to Cite
Freedman, J. L., Faerber, J., Kang, T. I., Dai, D., Fisher, B. T., Huang, Y.-S., Li, Y., Aplenc, R. and Feudtner, C. (2014), Predictors of antiemetic alteration in pediatric acute myeloid leukemia. Pediatr. Blood Cancer, 61: 1798–1805. doi: 10.1002/pbc.25108
The funding organization had no role in the design of the study beyond the critique offered by the peer-review process; and had no role in the conduct of the study, including the collection, analysis, and preparation of the data or the drafting, editing, review, or approval of the manuscript. The content is solely the responsibility of the authors.
- Issue online: 19 AUG 2014
- Version of Record online: 17 JUN 2014
- Manuscript Accepted: 28 APR 2014
- Manuscript Received: 21 FEB 2014
- Agency for Healthcare Research and Quality. Grant Number: 1RO1HS018425
- Pediatric Pharmacoepidemiology Training Program, University of Pennsylvania. Grant Number: T32HD064567
- Pfizer Pharmaceuticals
- supportive care
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).
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-HT3 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.
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.
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.