High-dose cytarabine dose modification reduces the incidence of neurotoxicity in patients with renal insufficiency.

Smith, G. Adair; Damon, Lauren E.; Rugo, Hope S.; Ries, Curt A.; Linker, Charles

doi:10.1200/jco.1997.15.2.833

Cited by 80 publications

(33 citation statements)

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“…This is likely due to concomitant comorbidities, different disease biology, and differential chemotherapy metabolism compared to younger patients. 7,19,20 For example, older patients have a higher incidence of unfavorable chromosomal abnormalities, a lower incidence of favorable ones, and are more likely to have secondary AML. 10,[21][22][23][24][25] Patients with high risk or advanced myelodysplastic syndrome (aMDS), also a condition affecting older adults, have a disease that runs an accelerated course with a similar prognosis to patients with AML.…”

Section: Introductionmentioning

confidence: 99%

Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

et al. 2004

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Older patients with acute myeloid leukemia (AML) and advanced myelodysplastic syndrome (aMDS) must decide between receiving intensive induction chemotherapy (IC) or nonintensive chemotherapy/best supportive care (NIC). Little information exists about what factors influence treatment decisions and what quality of life (QOL) is associated with treatment choices. We prospectively examined 43 patients 60 years or older who were interviewed at diagnosis and periodically over 1 year. IC choice was associated with younger age (66 vs 76 years, P ¼ 0.01) and AML diagnosis, but not with performance status, comorbidities, or QOL. In total, 63% of all patients reported not being offered other treatment options despite physician documentation of alternatives. Patient and physician estimates of cure differed significantly: 74% of patients estimated their chance of cure to be 50% or greater, yet for 89% of patients physician estimates of cure were 10% or less. IC patients experienced decreased QOL at 2 weeks, but rebounded to baseline and to NIC levels by 6 weeks. Initial QOL is not associated with treatment choice in older AML and aMDS patients. Regardless of treatment choice, patients report not being offered treatment options and overestimate their chances of cure. In IC patients, QOL decreases during hospitalization but rebounds after discharge.

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Section: Introductionmentioning

confidence: 99%

Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

et al. 2004

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“…Neurotoxicity with HDAC is thought to be related to accumulation of the neurotoxic metabolite ARA-CTP in the cerebrospinal fluid in patients with renal insufficiency [22]. In their retrospective analysis, Smith et al [37] devised a dose-modification algorithm for patients with renal impairment based on serum creatinine: (a) for patients with creatinine levels of 1.5-1.9 mg/dl or an increase in creatinine during treatment of 0.5-1.2 mg/dl, the cytarabine dose was reduced from 2-3 g/m 2 per day to 1 g/m 2 per day; and (b) for patients with creatinine levels Ն2 mg/dl or a change in creatinine Ͼ1.2 mg/dl, the dose was decreased to 0.1 g/m 2 per day.…”

Section: Cytarabinementioning

confidence: 99%

“…In spite of a correlation between elevated serum bilirubin and neurotoxicity, no algorithm for cytarabine dosing in patients with hepatic dysfunction has been developed [37].…”

Section: Cytarabinementioning

confidence: 99%

Commentary: Oncologic Drugs in Patients with Organ Dysfunction: A Summary

2007

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After completing this course, the reader will be able to:1. Describe the currently recommended dose adjustments for common chemotherapeutics in oncology patients with organ dysfunction.2. Explain the rationale for using phase I dose-escalation studies to determine appropriate chemotherapy dosing in patients with organ dysfunction.3. Discuss the limitations of the currently available studies to guide chemotherapy dose adjustment in patients with organ dysfunction.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThere are few prospective data regarding the pharmacokinetics and clinical toxicity of commonly used chemotherapeutics in cancer patients with organ dysfunction. Although increasing numbers of studies are investigating newer chemotherapeutics in patients with liver or kidney dysfunction, most guidelines for dosing, especially for established agents, remain empiric. This review describes the available data (both prospective and case study) evaluating the impact of renal and hepatic dysfunction on toxicity and dosing of commonly used chemotherapeutics and provides a practical summary for their use in this setting.

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“…Furthermore, it has been shown that avoidance of very high doses of the drug in patients with renal impairment and the administration of HD-ara-C on a once-daily rather than twice-daily schedule reduce the incidence of this syndrome (Smith et al, 1997).…”

Section: Acute Encephalopathymentioning

confidence: 99%

Chemotherapy Toxicity in Patients with Acute Leukemia

Vagace¹,

Gervasini²

2011

Acute Leukemia - The Scientist's Perspective and Challenge

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High-dose cytarabine dose modification reduces the incidence of neurotoxicity in patients with renal insufficiency.

Abstract: 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 from 3 to 2 g/m2 per dose; (2) modifying the ARA-C dose based on daily Cr values; and (3) administering HDAC on a once-daily rather than twice-daily schedule.

Cited by 80 publications

References 0 publications

Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

Commentary: Oncologic Drugs in Patients with Organ Dysfunction: A Summary

Chemotherapy Toxicity in Patients with Acute Leukemia

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