Clinical course of haemodialysis patients with malignancies and dose-adjusted chemotherapy.
BACKGROUND
Chemotherapy is not given routinely to patients with malignancies receiving chronic haemodialysis because evidence of a clear benefit is still lacking and severe side effects are feared. The aim of our retrospective study was to analyse the methods of dose adjustment and the clinical course of chronic haemodialysis patients with malignancies treated by chemotherapy.


METHODS
Between 1985 and 2001, a total of 48 cycles of 21 chemotherapy protocols were administered to 16 dialysis patients with nine haemoblastic and seven solid malignancies. We compared the dose actually administered with that theoretically derived from the proportional dose reduction rule of Dettli and the rule of Giusti and Hayton, using published pharmacokinetic parameters.


RESULTS
Kaplan-Meier estimates of median survival time were 30 months in patients with haemoblastic malignancies and 10 months for patients with solid malignancies. Eleven chemotherapies were administered in standard dosages and 10 chemotherapies in reduced dosages (39-80% of the regular dose); in all therapies, however, the dose was significantly higher than proposed by the Dettli rule (P<0.01).


CONCLUSIONS
Chemotherapy in patients with haemodialysis is feasible. Individual dose adjustment should be performed on the basis of pharmacokinetic data and the general condition of the patient, but it is still a matter of expert judgement, as there is no formal evidence available.
Boesler
Benjamin
B
Division of Nephrology, University Hospital Ulm, Germany.
Czock
David
D
Keller
Frieder
F
Griesshammer
Martin
M
Seufferlein
Thomas
T
Karges
Wolfram
W
Rasche
Franz Maximilian
FM
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology*; D006435:Renal Dialysis; D012189:Retrospective Studies
D000970:Antineoplastic Agents