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Neutropenic sepsis rates in patients receiving BEP chemotherapy using olanzapine and reduced doses of dexamethasone compared to a standard antiemetic regimen

Gjafa, E; Ng, K; Grunewald, T; Galazi, M; Skyllberg, E; Wilson, P; Alifrangis, C; (2021) Neutropenic sepsis rates in patients receiving BEP chemotherapy using olanzapine and reduced doses of dexamethasone compared to a standard antiemetic regimen. BJU International , 127 (2) pp. 205-211. 10.1111/bju.15175. Green open access

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Abstract

BACKGROUND: Bleomycin, Etoposide and Cisplatin (BEP) chemotherapy is the conventional treatment regimen for patients with germ cell tumours. The regimen is highly emetogenic and immunosuppressive. High dose steroids are often prescribed with this regimen as antiemetic prophylaxis but may have adverse effects in the context of immunosuppression. OBJECTIVE: To investigate whether the use of a steroid-sparing antiemetic protocol (substituting dexamethasone with olanzapine) affects the incidence of neutropenia and associated hospital admissions in patients receiving BEP chemotherapy. DESIGN, SETTING, PARTICIPANTS AND STATISTICAL ANALYSIS: Records from 108 patients who received BEP in St Bartholomew's Hospital, London were divided into two groups by antiemetic regimen. Group 1 (treated 2008-2013) were treated with a steroid-containing antiemetic protocol and Group 2 (treated 2014-2017) were given a steroid-sparing protocol, i.e. using olanzapine. Outcomes include incidence of neutropenia at nadir blood count, severity of neutropenia, hospital admissions due to febrile neutropenia (FN) and baseline risk factors associated with FN. Statistical analyses were performed using two-sided Chi-squared tests. RESULTS AND LIMITATIONS: Baseline characteristics were balanced in age, gender, histology, and proportion of IGCCCG poor-risk patients. The incidence of neutropenia of any grade (Group 1, 96.2%, Group 2, 98.1%) was comparable although Group 2 had more patients with severe neutropenia (77.7%, G1 vs 88.8%, G2). There was a significant difference in FN Incidence (22%, G1 vs 7.5%, in G2, p=0.030). Most cases of FN occurred in Cycle 1. Two baseline characteristics were over-represented in patients who developed FN - females and patients ≥ 50 years old. CONCLUSION: By comparing two cohorts who received prophylactic antibiotics, our audit suggests that rates of febrile neutropenia related admissions have decreased in the cohort of patients that we employed a steroid-sparing antiemetic protocol.

Type: Article
Title: Neutropenic sepsis rates in patients receiving BEP chemotherapy using olanzapine and reduced doses of dexamethasone compared to a standard antiemetic regimen
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/bju.15175
Publisher version: https://doi.org/10.1111/bju.15175
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Antiemetics, BEP chemotherapy, Febrile neutropenia, Olanzapine, Steroids
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10105324
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