Safety and efficacy of a continuous infusion, patient controlled anti-emetic pump to facilitate outpatient administration of high-dose chemotherapy.
We evaluated the combination of diphenhydramine, lorazepam, and dexamethasone delivered as a continuous i.v. infusion via an ambulatory infusion pump with patient-activated intermittent dosing (BAD pump) for prevention of acute and delayed nausea/vomiting in patients receiving high-dose chemotherapy (HDC) for peripheral blood progenitor cell (PBPC) mobilization (MOB) or prior to autologous PBPC rescue. The BAD pump was titrated to patient response and tolerance, and continued until the patient could tolerate oral anti-emetics. Forty-four patients utilized the BAD pump during 66 chemotherapy courses, 34 (52%) for MOB and 32 (48%) for HDC with autologous PBPC rescue. The median number of days on the BAD pump during MOB and HDC was 3 (1-6) and 9 (2-19) days, respectively. Complete overall or complete emesis control occurred on 94% of MOB and 89% of HDC treatment days during chemotherapy administration and 72% and 43%, respectively, following chemotherapy administration. Eighty-three percent of MOB and 55% of HDC treatment days were associated with no nausea. While on the BAD pump, no patient experienced severe toxicity or required hospitalization for management of nausea/vomiting. The BAD pump was safe and effective in minimizing nausea and vomiting associated with HDC, and thus, eliminated the need for hospitalization for management of chemotherapy-induced nausea and vomiting.
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S
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Blood and Marrow Transplant Program, Oncology and Hematology Associates and Saint Luke's Hospital of Kansas City, Kansas City, MO 64111, USA.
Cord
M
M
Howard
S
S
Coon
J
J
Belt
R
R
Geller
R
R
D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D000932:Antiemetics / Q000008:administration & dosage* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000628:therapy; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004155:Diphenhydramine / Q000008:administration & dosage* / Q000627:therapeutic use; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008140:Lorazepam / Q000008:administration & dosage* / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012449:Safety; D012648:Self Care / Q000295:instrumentation*; D013852:Thiotepa / Q000008:administration & dosage / Q000009:adverse effects; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D000932:Antiemetics; D003561:Cytarabine; D005047:Etoposide; D003907:Dexamethasone; D004155:Diphenhydramine; D003520:Cyclophosphamide; D013852:Thiotepa; D016190:Carboplatin; D008140:Lorazepam; D002330:Carmustine