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Titolo:
HIGH-DOSE CYTARABINE DOSE MODIFICATION REDUCES THE INCIDENCE OF NEUROTOXICITY IN PATIENTS WITH RENAL-INSUFFICIENCY
Autore:
SMITH GA; DAMON LE; RUGO HS; RIES CA; LINKER CA;
Indirizzi:
UNIV CALIF SAN FRANCISCO,DIV HEMATOL ONCOL,BOX A-502,505 PARNASSUS AVE SAN FRANCISCO CA 94143 UNIV CALIF SAN FRANCISCO,DIV HEMATOL ONCOL SAN FRANCISCO CA 94143
Titolo Testata:
Journal of clinical oncology
fascicolo: 2, volume: 15, anno: 1997,
pagine: 833 - 839
SICI:
0732-183X(1997)15:2<833:HCDMRT>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE MYELOID-LEUKEMIA; CENTRAL NERVOUS-SYSTEM; KILLS POSTMITOTIC NEURONS; CYTOSINE-ARABINOSIDE; ARA-C; CEREBELLAR TOXICITY; POSTREMISSION CHEMOTHERAPY; RISK-FACTORS; PHARMACOKINETICS; ADULTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
28
Recensione:
Indirizzi per estratti:
Citazione:
G.A. Smith et al., "HIGH-DOSE CYTARABINE DOSE MODIFICATION REDUCES THE INCIDENCE OF NEUROTOXICITY IN PATIENTS WITH RENAL-INSUFFICIENCY", Journal of clinical oncology, 15(2), 1997, pp. 833-839

Abstract

Purpose: To determine the impact of high-dose cytarabine (ARA-C) (HDAC) dose modification, based on renal function, on the incidence of neurotoxicity (NT). Patients and Methods: We retrospectively analyzed therecords of 256 patients treated with HDAC (greater than or equal to 2.0 g/m(2) per dose) for acute myelogenous leukemia (AML) at the University of California, San Francisco (UCSF). From 1985 to 1994, a total of 358 cycles of HDAC were administered, using either a twice-daily schedule (n = 208) or a once-daily regimen (n = 48). In 1989, a dose-modification algorithm was initiated at our institution, which reduced ARA-C doses in the setting of renal insufficiency (RI). For patients witha serum creatinine (Cr) level of 1.5 to 1.9 mg/dL during treatment, or an increase in Cr during treatment (Delta Cr) of 0.5 to 1.2 mg/dL, ARA-C was decreased to 1 g/m(2) per dose. For patients with a Cr greater than or equal to 2.0 mg/dL or a Delta Cr greater 1.2 mg/dL, the dosewas reduced to 0.1 g/m(2)/d. Results: Overall, the incidence of NT was 16% (34 of 208) for patients treated with twice-daily HDAC and 0% (none of 48) for patients treated with daily HDAC (P = .003). NT occurred more often in patients treated on a twice-daily schedule with 3 g/m(2) per dose compared with 2 g/m(2) per dose (25% v 8%; P = .009). NT occurred in 55% of the twice-daily-treated patients with RI, compared with 7% of those with normal renal function (P = .00001). In patients with RI, NT occurred in none of the 11 dose-modified cycles versus fiveof 11 (45%) total unmodified cycles (P = .01). None of 14 patients treated with once-daily HDAC given during RI developed NT, compared to 55% of patients (23 of 42) receiving twice-daily HDAC during RI (P = .009). By univariate analysis, NT was not associated with patient age orserum alkaline phosphatase, but NT was significantly increased in patients treated with twice-daily HDAC when the serum bilirubin was greater than or equal to 2.0 mg/dL compared with twice-daily HDAC given when the total bilirubin was less than 2.0 mg/dL (33% v 14%; P = .017). Multivariate analysis confirmed that RI was the most significant risk factor associated with the development of NT. Conclusion: HDAC NT is strongly associated with RI. The risk of HDAC NT can be reduced by the following: (1) routinely reducing the ARA-C dose form 3 to 2 g/m(2) perdose; (2) modifying the ARA-C dose based on daily Cr values; and (3) administering HDAC on a once-daily rather than twice-daily schedule. (C) 1997 by American Society of Clinical Oncology.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/11/20 alle ore 12:57:57