NEW YORK (Reuters Health) – Chemotherapy-induced vomiting in children who are treated intrathecally can be prevented with the preoperative use of a single dose of intravenous ondansetron, New York researchers report in the December issue of the Journal of Pediatric Hematology/Oncology.
Dr. Robert I. Parker and colleagues, at the State University of New York at Stony Brook, randomized 26 children between the ages of 18 months and 15 years to receive either ondansetron at 0.15 mg/kg or 0.45 mg/kg or placebo 30 minutes before intrathecal chemotherapy. The study was a crossover trial, with each child receiving each of the three protocols at least once and acting as his own control.
Children were undergoing courses of either intrathecal methotrexate alone or a combination of methotrexate, hydrocortisone, and Ara-C for central nervous system leukemia.
The investigators found that 62.7% of children experienced vomiting while receiving placebo. The incidence of vomiting was 27.7% with low-dose ondansetron and 14.6% with the higher dose of ondansetron. Overall, 88.5% of the children experienced at least one episode of vomiting post-chemotherapy.
Dr. Parker and his team write: "A dose of 0.15 mg/kg may be a reasonable starting dose for patients who have had postintrathecal chemotherapy vomiting or who are thought to be at significant risk for this side effect." If that dose does not control vomiting, then the child should receive the higher dose of 0.45 mg/kg for subsequent rounds of intrathecal chemotherapy, they recommend.
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