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Infusion reactions are common after high-dose carmustine in BEAM chemotherapy and are not reduced by lengthening the time of administration.
- Source :
-
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2017 Jan; Vol. 25 (1), pp. 205-208. Date of Electronic Publication: 2016 Sep 10. - Publication Year :
- 2017
-
Abstract
- Purpose: Carmustine (BCNU) is used in the conditioning regimens BEAM and CBV for autologous stem cell transplantation. Carmustine-related infusion reactions, while not described in the BEAM literature, occurred in 95 % of patients who received CBV. The most common symptoms include flushing, facial pain, headache, and hypotension. These reactions have been attributed to the absolute ethanol that is used in the reconstitution process or alternatively by a direct effect of carmustine. It is currently recommended that carmustine 300 mg/m <superscript>2</superscript> be infused over at least 100 min (3-5 mg/m <superscript>2</superscript> /min). Prior to October 2014, carmustine infusions were given over 90 min but were changed to 120 min based on the above recommendation. We compared the two infusion rates in patients receiving BEAM to see if lengthening the infusion decreased the frequency of reactions.<br />Methods: Overall, 100 patients received BCNU as part of BEAM or Zevalin BEAM and were equally divided between 90 and 120 min infusion times. The primary outcome was the incidence of infusion-related reactions which were graded based on CTCAE 4.03 descriptions of flushing and infusion-related reactions. We also evaluated the impact of premedication as well as the efficacy of medications used to treat infusion reactions.<br />Results: Between the years 2013-2016, there were 50 patients who received BCNU over 90 min and 50 patients over 120 min. There were no significant differences observed for diagnosis, age and gender between the two groups. Twenty-eight (56 %) in the 90-min and 26 (52 %) in the 120-min infusion intervals developed a reaction (pā=ā0.6882). Of the patients that developed a reaction, 19 patients (67 %) in the 90-min and all 26 patients (100 %) in the 120-min infusion were given premedications predominately acetaminophen, in addition to dexamethasone. Among reacting patients, 57 % of the 90-min and 65 % of the 120-min groups received additional intervention (pā=ā0.53).<br />Conclusion: Infusion reactions during high-dose BCNU are common and are not clearly reduced by modestly extending the duration of infusion or giving premedications.
- Subjects :
- Adolescent
Adult
Aged
Carmustine administration & dosage
Carmustine adverse effects
Cytarabine administration & dosage
Cytarabine adverse effects
Dose-Response Relationship, Drug
Drug Administration Schedule
Etoposide administration & dosage
Etoposide adverse effects
Female
Hematopoietic Stem Cell Transplantation methods
Humans
Infusions, Intravenous
Male
Melphalan administration & dosage
Melphalan adverse effects
Middle Aged
Transplantation Conditioning adverse effects
Transplantation Conditioning methods
Transplantation, Autologous
Young Adult
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Antineoplastic Combined Chemotherapy Protocols adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1433-7339
- Volume :
- 25
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 27614867
- Full Text :
- https://doi.org/10.1007/s00520-016-3399-4