Resource Utilization and Toxicities After Carboplatin/Etoposide/Melphalan and Busulfan/Melphalan for Autologous Stem Cell Rescue in High-Risk Neuroblastoma Using a National Administrative Database
| Autor: | Alix E. Seif, Yimei Li, Adjoa Mante, Brian T. Fisher, Richard Aplenc, Kelly D. Getz, Ami V. Desai, Rochelle Bagatell, Vera Huang |
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| Rok vydání: | 2016 |
| Předmět: |
Melphalan
medicine.medical_specialty medicine.medical_treatment law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine law Internal medicine medicine Etoposide Mechanical ventilation Chemotherapy business.industry Incidence (epidemiology) Hematology Intensive care unit Carboplatin Surgery Oncology chemistry 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health business Busulfan 030215 immunology medicine.drug |
| Zdroj: | Pediatric Blood & Cancer. 63:901-907 |
| ISSN: | 1545-5009 |
| DOI: | 10.1002/pbc.25893 |
| Popis: | Background High-dose chemotherapy with autologous stem cell rescue (ASCR) is a key component of high-risk neuroblastoma therapy. Resources required to support patients treated with ASCR conditioning regimens [carboplatin/etoposide/melphalan (CEM) and busulfan/melphalan (BuMel)] have not been directly compared. Procedure An administrative database was used to analyze resource utilization and outcomes in a cohort of high-risk neuroblastoma patients. Patients were followed for 60 days from start of conditioning or until death. Length of hospitalization, length of intensive care unit (ICU) level of care, incidence of sepsis and sinusoidal obstruction syndrome (SOS), and duration of use of specific supportive care resources were analyzed. Results Six of 171 CEM patients and zero of 59 BuMel patients died during the study period (P = 0.34). Duration of hospitalization was longer following BuMel (median 35 vs. 31 days; P = 0.01); however, there was no difference in duration of ICU-level care. Antibiotic use was longer following CEM (median 19 vs. 15 days; P = 0.01), as was antihypertensive use (median 5 vs. 1.6 days; P = 0.0024). Duration of opiate and nonnarcotic analgesic use was longer following CEM early in the study period. Resources consistent with a diagnosis of SOS were used in a higher proportion of BuMel patients. A higher proportion of BuMel treated patients required mechanical ventilation (17% vs. 6%; P = 0.03). Conclusions We used administrative billing data to compare resources associated with ASCR conditioning regimens. CEM patients required more extended use of analgesics, antibiotics, and antihypertensives, while duration of hospitalization was longer, and SOS and the use of mechanical ventilation were more frequent following BuMel. |
| Databáze: | OpenAIRE |
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