title: Co-administration of dexamethasone increases severity and accelerates onset day of neutropenia in bladder cancer patients on methotrexate, vinblastine, adriamycin and cisplatin chemotherapy: a retrospective cohort study.
abstract: BACKGROUND
  Bladder cancer patients receiving methotrexate, vinblastine, adriamycin and cisplatin (MVAC) chemotherapy are co-administered with dexamethasone as an anti-emetic. We examined whether or not dexamethasone affects the severity and onset day of MVAC-induced severe neutropenia.
  
  
  METHODS
  This was a retrospective study of bladder cancer patients treated with MVAC chemotherapy with or without dexamethasone as an antiemetic at Kanazawa University Hospital during January 2005 - December 2009. Patients were categorized into three groups; no dexamethasone use (Dex (-)), dexamethasone on day 2 (Dex 1 day), and dexamethasone on days 2, 3 and 4 (Dex multiday). We evaluated the incidence of grade 3/4 neutropenia and the day of onset of first severe neutropenic episode during the first course of MVAC chemotherapy. Logistic regression was used to investigate whether co-administration of dexamethasone was a risk factor for severe neutropenia.
  
  
  RESULTS
  Episodes of grade 3/4 neutropenia occurred in 3 out of 6 (50.0%), 11 out of 12 (91.7%) and 6 out of 6 (100%) patients in the Dex (-), Dex 1 day, and Dex multiday groups, respectively. The appearance day of first severe neutropenia in the Dex multiday group (13.2 ± 1.0) was significantly accelerated compared to the Dex (-) group (17.7 ± 2.1). Univariate logistic regression analysis revealed that dexamethasone is a risk factor for severe neutropenia (OR 17.0; 95%CI: 1.3-223.1).
  
  
  CONCLUSIONS
  Co-administration of dexamethasone for anti-emesis brings forward the first appearance of neutropenia, and increases the severity of neutropenia, in bladder cancer patients receiving MVAC chemotherapy.
authors.affiliation: Division of Life Sciences, Graduate School of Natural Science and Technology, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan ; Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Itai
authors.affiliation: Department of Clinical Drug Informatics, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Suga
authors.affiliation: Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hara
authors.affiliation: Department of Urology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Urology, Public Central Hospital of Matto Ishikawa, 3-8 Kuramitsu, Hakusan, 924-8588 Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Department of Urology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: Department of Clinical Drug Informatics, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Ishizaki
authors.affiliation: Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan ; Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Shimada
authors.affiliation: Department of Urology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mizokami
authors.affiliation: Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan ; Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
authors.forename: Yoshimichi
authors.initials: Y
authors.lastname: Sai
keywords: Adverse effect; Bladder cancer; Cancer chemotherapy; Dexamethasone; Neutropenia