mercaptopurine and Vomiting

Shortly before the all-trans retinoic acid (ATRA) era, the GIMEMA cooperative group initiated a randomized study comparing idarubicin (IDA) alone with IDA plus arabinosylcytosine (Ara-C) as induction treatment in patients with newly diagnosed hypergranular acute promyelocytic leukemia (APL). Of the 257 patients evaluable for induction treatment, 131 were randomized to receive IDA alone (arm A) and 126 to receive IDA + Ara-C (arm B). Treatment in arm A consisted of 10 mg/m(2) IDA daily for 6 consecutive days, whereas in arm B it consisted of 12 mg/m(2) IDA daily for 4 days combined with 200 mg/m(2) Ara-C daily in continuous infusion for 7 days. Once in complete remission (CR), patients received 3 consolidation courses of standard chemotherapy, and those still in CR at the end of the consolidation were randomized to receive or not receive 1 mg/kg 6-mercaptopurine daily and intramuscular injections of 0.25 mg/kg methotrexate weekly for 2 years. Overall, 100 (76.3%) patients in arm A and 84 (66.6%) patients in arm B achieved CR (P = NS). Event-free survival (EFS) rates were 35% and 23% for patients in arm A and arm B, respectively (P =.0352). Multivariate analysis revealed that EFS was favorably influenced by induction treatment with IDA alone (P =.0352) and unfavorably influenced by white blood cell (WBC) counts greater than 3000/microL (P =.0001) and increasing age (P =.0251). These results indicate that anthracycline monochemotherapy with IDA favorably influences the EFS of patients with newly diagnosed hypergranular APL.

Topics: Adolescent; Adult; Age Factors; Antibiotics, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Chemical and Drug Induced Liver Injury; Child; Cytarabine; Disease-Free Survival; Female; Follow-Up Studies; Hemorrhage; Humans; Idarubicin; Infections; Leukemia, Promyelocytic, Acute; Leukocyte Count; Male; Mercaptopurine; Methotrexate; Middle Aged; Remission Induction; Treatment Outcome; Vomiting

The purpose of this study was to determine the effectiveness of intravenous ondansetron in preventing vomiting after the administration of intrathecal chemotherapy in children.. Twenty-six children (ages 18 mo to 15 y) receiving intrathecal chemotherapy with either methotrexate or the combination of methotrexate, hydrocortisone, and Ara-C for the prophylactic treatment of central nervous system leukemia were randomly assigned to receive an infusion of normal saline or ondansetron at one of two doses (0.15 or 0.45 mg/kg) 30 minutes before undergoing the procedure. One hundred forty-six infusions were administered (51 placebo, 47 at the lower ondansetron dose, and 48 at the higher dose). Each patient acted as his or her own control, and each patient was studied at least three times.. Twenty-three of 26 patients (88.5%) had postprocedural vomiting on at least one occasion. At least one episode of vomiting occurred during the 24 hours after the procedure in fifty-two of the procedures (35.6%). The incidence of vomiting was significantly greater after infusion of placebo than after either low-dose or high-dose ondansetron. The likelihood of severe vomiting was even more significantly reduced by the preadministration of ondansetron. Almost all of the intrathecal treatments associated with severe vomiting occurred after the infusion of placebo.. Vomiting induced by intrathecal chemotherapy can be greatly reduced by the intravenous administration of ondansetron before the procedure, and severe vomiting can be virtually eliminated.

Topics: Adolescent; Antiemetics; Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Cross-Over Studies; Cytarabine; Dose-Response Relationship, Drug; Double-Blind Method; Female; Headache; Humans; Hydrocortisone; Injections, Intravenous; Leukemia; Male; Mercaptopurine; Methotrexate; Nausea; Ondansetron; Risk; Serotonin Antagonists; Treatment Outcome; Vincristine; Vomiting

Topics: Adenocarcinoma; Anemia; Bone Marrow Diseases; Carcinoma, Squamous Cell; Chemical and Drug Induced Liver Injury; Clinical Trials as Topic; Colonic Neoplasms; Humans; Leukopenia; Lung Neoplasms; Mercaptopurine; Nausea; Neoplasms; Rectal Neoplasms; Stomach Neoplasms; Thrombocytopenia; Vomiting

The aim of this questionnaire-based survey was to determine the 'acceptability' of Xaluprine®, a new oral liquid formulation of mercaptopurine, when administered chronically to children during the maintenance treatment phase of acute lymphoblastic leukaemia.. This was a single centre survey of children (aged 3 to 16 years) and their parents at a routine follow-up visit during the maintenance phase of acute lymphoblastic leukaemica treatment. The questionnaire probed for their views on overall acceptability such as taste, smell, incidences of vomiting, ease and willingness to take Xaluprine® on a daily basis, and utilised a 5-point facial hedonic scale (1 = bad, 5 = good) as well as open/closed questions.. Twenty-two children were recruited; 17 (77%) scored taste between 3 and 5 ('okay' to 'good') and 20 (91%) scored smell between 3 and 5. Only four children (18%) reported an aftertaste. Of the five children (23%) who scored taste as 1 or 2 ('bad'), three found taking all oral medicines difficult. Six children (27%) reported vomiting, but this was not considered related to Xaluprine®. Seven children (32%) sometimes complained that they did not want to take Xaluprine®; 15 (68%) never complained. In response to the question, 'How easy is it for you to take Xaluprine®?' 18 children (82%) reported that it was 'Easy all the time.' This was more favourable than other oral liquid medicines that they were taking concurrently.. The results of this survey show that Xaluprine® has good overall acceptability in the paediatric population and suggests that Xaluprine® is an important, alternative, age-appropriate formulation of mercaptopurine.

Topics: Adolescent; Antimetabolites, Antineoplastic; Chemistry, Pharmaceutical; Child; Child, Preschool; Drug Compounding; Female; Follow-Up Studies; Humans; Male; Mercaptopurine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Surveys and Questionnaires; Suspensions; Taste; Vomiting

Topics: Acetazolamide; Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Chlorthalidone; Cyclophosphamide; Cytarabine; Daunorubicin; Diagnosis, Differential; Headache; Humans; Intracranial Hypertension; Male; Mercaptopurine; Methotrexate; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Sinus Thrombosis, Intracranial; Vincristine; Vomiting

Topics: Animals; Antineoplastic Agents; Blood Platelets; Bone Marrow; Bone Marrow Cells; Deoxyribonucleosides; Diarrhea; Dogs; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Erythrocyte Count; Feeding and Eating Disorders; Female; Haplorhini; Hematocrit; Humans; Injections, Intravenous; Leukocyte Count; Leukopenia; Lymphocytes; Macaca; Male; Mercaptopurine; Neutrophils; Thrombocytopenia; Time Factors; Vomiting

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Child; Child, Preschool; Colitis, Ulcerative; Female; Follow-Up Studies; Humans; Leukopenia; Male; Mercaptopurine; Nausea; Prednisone; Radiography; Recurrence; Sulfasalazine; Time Factors; Vomiting

Topics: Adolescent; Anemia, Aplastic; Antineoplastic Agents; Central Nervous System; Child; Child, Preschool; Cyclophosphamide; Daunorubicin; Diarrhea; Drug Combinations; Female; Follow-Up Studies; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Nausea; Pneumonia, Pneumocystis; Prednisone; Radiotherapy; Recurrence; Remission, Spontaneous; Stomatitis, Aphthous; Vincristine; Vomiting

Topics: Adolescent; Adult; Aged; Allopurinol; Anaphylaxis; Asparaginase; Blood Coagulation Disorders; Cytarabine; Daunorubicin; Drug Hypersensitivity; Female; Fever; Gastrointestinal Hemorrhage; Hallucinations; Humans; Hyperglycemia; Injections, Intravenous; Jaundice; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Liver; Male; Mercaptopurine; Methotrexate; Middle Aged; Oral Hemorrhage; Prednisone; Thioguanine; Uremia; Vincristine; Vomiting

Topics: Antineoplastic Agents; Central Nervous System Diseases; Child; Clinical Laboratory Techniques; Drug Therapy; Headache; Humans; Intracranial Pressure; Leukemia; Mercaptopurine; Methotrexate; Neoplasms; Papilledema; Prednisone; Vomiting

Topics: Adolescent; Aminosalicylic Acid; Aminosalicylic Acids; Anti-Bacterial Agents; Antiemetics; Calcium Chloride; Child; Drug Therapy; Escherichia coli Infections; Gastroenteritis; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Mercaptopurine; Toxicology; Vomiting