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Predictors of antiemetic alteration in pediatric acute myeloid leukemia

Authors

  • Jason L. Freedman MD, MSCE,

    Corresponding author
    1. Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    • Correspondence to: Jason L. Freedman, Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 10207, Philadelphia, PA 19104.

      Email: freedmanj@email.chop.edu

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  • Jennifer Faerber PhD,

    1. Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Tammy I. Kang MD, MSCE,

    1. Divisions of Oncology and Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Dingwei Dai PhD, MSc,

    1. Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Brian T. Fisher DO, MSCE,

    1. Division of Infectious Diseases/Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, Pennsylvania
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  • Yuan-Shung Huang MS,

    1. Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Yimei Li PhD,

    1. Division of Oncology/Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, Pennsylvania
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  • Richard Aplenc MD, PhD,

    1. Division of Oncology/Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, Pennsylvania
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  • Chris Feudtner MD, PhD, MPH

    1. Division of General Pediatrics/Center for Pediatric Clinical Effectiveness/Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, Pennsylvania
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  • 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.
  • 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.

ABSTRACT

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-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.

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.

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