Dexrazoxane use in pediatric patients with acute lymphoblastic or myeloid leukemia from 1999 and 2009: Analysis of a national cohort of patients in the pediatric health information systems database†
Corresponding Author
Dana M. Walker MD, MSCE
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Division of Oncology, The Children's Hospital of Philadelphia, Colket Translational Research Building, Room 10207, 3501 Civic Center Boulevard, Philadelphia, PA 19104.===Search for more papers by this authorBrian T. Fisher DO, MSCE
Division of Infectious Diseases, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorAlix E. Seif MD, MPH
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Search for more papers by this authorYuan-Shung V. Huang MS
Division of Infectious Diseases, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Search for more papers by this authorKari Torp
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorYimei Li PhD
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorRichard Aplenc MD, PhD
Division of Infectious Diseases, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorCorresponding Author
Dana M. Walker MD, MSCE
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Division of Oncology, The Children's Hospital of Philadelphia, Colket Translational Research Building, Room 10207, 3501 Civic Center Boulevard, Philadelphia, PA 19104.===Search for more papers by this authorBrian T. Fisher DO, MSCE
Division of Infectious Diseases, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorAlix E. Seif MD, MPH
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Search for more papers by this authorYuan-Shung V. Huang MS
Division of Infectious Diseases, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Search for more papers by this authorKari Torp
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorYimei Li PhD
Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorRichard Aplenc MD, PhD
Division of Infectious Diseases, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Bristol-Myers Squibb, Pennington, NJ
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Search for more papers by this authorConflict of interest: Nothing to declare.
Abstract
Background
Acute lymphoblastic (ALL) and myeloid leukemia (AML) account for approximately 26% of pediatric cancers. Anthracyclines are widely used to treat these leukemias, but dosing is limited by cardiotoxicity. Data support the efficacy of dexrazoxane as a cardioprotectant in children; however, dexrazoxane use in children is not universally accepted due to concerns about toxicity, impact on the antitumor effect of anthracyclines, and risk of secondary malignant neoplasms (SMN).
Procedure
We conducted a retrospective cohort study to describe patterns of dexrazoxane use in pediatric patients with ALL or AML using the Pediatric Health Information Systems (PHIS) database. Patients identified as having de novo ALL and AML at these PHIS hospitals were included.
Results
Of 8,733 patients with ALL and 2,556 with AML, 207 (2.4%) and 52 (2.0%) received dexrazoxane, respectively. Dexrazoxane use was greater in older children with ALL and AML and in black patients and males with ALL. Dexrazoxane use varied across time and by region in ALL, but not in AML. Prescribing practices differed across institutions and most patients received the first dose early or late after the start of leukemia treatment.
Conclusions
Dexrazoxane administration is limited in patients with ALL and AML and prescribing practices vary across the country. Further work is necessary to understand how dexrazoxane is used in patients at highest risk of developing cardiotoxicity and to define its true effect on the development of SMNs. Pediatr Blood Cancer 2013; 60: 616–620. © 2012 Wiley Periodicals, Inc.
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