Skip to main content
. Author manuscript; available in PMC: 2019 Jun 6.
Published in final edited form as: Pediatr Blood Cancer. 2011 Apr 4;57(2):191–198. doi: 10.1002/pbc.23114

TABLE 2.

Health Questions, Recommendations and Panel Remarks

Panel’s Remarks on Recommendation Interpretation:

  • All emetogenic classifications are strong recommendations

  • Classifications are most applicable to chemotherapy-naïve pediatric patients

Health Questions and Recommendations:
1. Which chemotherapy regimens are highlyα emetogenic?
Single-agent regimens:

  • Asparaginase (Erwinia) IV ≥ 20,000IU/m2/dose*

  • Busulfan IV ≥ 0.8mg/kg/dose*

  • Busulfan PO ≥ 1mg/kg/dose*

  • Carboplatin IV ≥ 175mg/m2/dose†

  • Cisplatin IV ≥ 12mg/m2/dose†

  • Cyclophosphamide IV ≥ 1200mg/m2/dose†

  • Cytarabine IV ≥ 3g/m2/day

  • Dactinomycin IV ≥ 1.35mg/m2/dose†

  • Doxorubicin IV ≥ 30mg/m2/dose*

  • Idarubicin PO ≥ 30mg/m2/dose*

  • Melphalan IV*

  • Methotrexate IV ≥ 12g/m2/dose

Multiple-agent regimens:

  • Cyclophosphamide ≥ 600mg/m2/dose + Dactinomycin ≥ 1mg/m2/dose*

  • Cyclophosphamide ≥ 400mg/m2/dose + Doxorubicin ≥ 40mg/m2/dose†

  • Cytarabine ≥ 90mg/m2/dose IV + Methotrexate IV ≥ 150mg/m2/dose*

  • Cytarabine IV + Teniposide IV*

  • Dacarbazine ≥ 250mg/m2/dose IV + Doxorubicin IV ≥ 60mg/m2/dose*

  • Dactinomycin 900mcg/m2/dose IV + Ifosfamide 3g/m2/dose

  • Etoposide IV ≥ 60mg/m2/dose + Ifosfamide IV ≥ 1.2g/m2/dose*

  • Etoposide IV ≥ 250mg/m2/dose + Thiotepa IV ≥ 300mg/m2/dose*

2. Which single-agent and multiple-agent chemotherapy regimens are moderatelyβ emetogenic?
Single-agent regimens:

  • Cyclophosphamide IV 1000mg/m2/dose†

  • Cytarabine IV 75mg/m2/dose*

  • Dactinomycin IV 10mcg/kg/dose*

  • Doxorubicin IV 25mg/m2/dose†

  • Gemtuzumab IV 3–9mg/m2/dose

  • Imatinib PO > 260mg/m2/day*

  • Interferon alpha IV 15–30 million U/m2/day*

  • Ixabepilone IV 3–10mg/m2/dose*

  • Methotrexate IV 5g/m2/dose†

  • Methotrexate IT*

  • Topotecan PO 0.4–2.3mg/m2/day*

Multiple-agent regimens:

  • Cytarabine IV 100mg/m2/dose + Daunorubicin IV 45mg/m2/dose + Etoposide IV 100mg/m2/dose + Prednisolone PO + Thioguanine PO 80mg/m2/dose*

  • Cytarabine 60 or 90mg/m2/dose + Methotrexate 120mg/m2/dose

  • Liposomal doxorubicin IV 20–50mg/m2/dose + Topotecan PO 0.6mg/m2/day*

3. Which single-agent and multiple-agent chemotherapy regimens are of lowχ emetogenicity?
Single-agent regimens:

  • Cyclophosphamide IV 500mg/m2/dose†

  • Cyclophosphamide PO 2–3mg/kg/dose*

  • Dasatinib PO 60–120mg/m2/dose*

  • Erlotinib PO 35–150mg/m2/day*

  • Everolimus PO 0.8–9mg/m2/day*

  • Gefitinib PO 150–500mg/m2/day*

  • Imatinib PO 260mg/m2/day*

  • Mafosfamide IT 1–6.5mg/dose*

  • Melphalan PO 0.2mg/kg/dose*

  • Mercaptopurine PO ≤ 4.2mg/kg/dose*

  • Methotrexate 38–83mg/m2/dose IV*

  • Mitoxantrone IV ≤ 33mg/m2/dose*

  • Procarbazine PO 50–100mg/m2/day*

  • Ruxolitinib PO 15–21mg/m2/dose*

  • Selumetinib PO 20–30mg/m2/dose*

  • Sorafenib PO 150–325mg/m2/dose*

  • Temozolomide PO 200mg/m2/dose*

Multiple-agent regimens:

  • Cytarabine IV 60mg/m2/dose + Methotrexate IV 90mg/m2/dose*

4. Which single-agent and multiple-agent chemotherapy regimens are minimallyδ emetogenic?
Single-agent regimens:

  • Asparaginase (E. coli) IM ≤ 6000IU/m2/dose*

  • Asparaginase (Erwinia) IM ≤ 25,000IU/m2/dose*

  • Chlorambucil ≤ 0.2mg/kg/day PO*

  • Doxorubicin IV 10mg/m2/dose*

  • Liposomal doxorubicin IV ≤ 50mg/m2/dose*

  • Mercaptopurine PO ≤ 4.2mg/kg/dose

  • Methotrexate PO/SC ≤ 10mg/m2/dose*

  • Pracinostat 25–45 mg/m2/dose PO*

  • Vincristine IV ≤ 1.5mg/m2/dose*

Multiple-agent regimens:

  • Cisplatin ≤ 60mg/m2/dose intra-arterially + doxorubicin ≤ 30mg/m2/dose intra-arterially*

  • Cisplatin ≤ 60mg/m2/dose intra-arterially + pirarubicin ≤ 30mg/m2/dose intra-arterially*

  • Mercaptopurine PO ≤ 2.5mg/kg/dose + Methotrexate PO ≤ 0.1mg/kg/day*

Frequency of emesis in the absence of prophylaxis,

α

> 90%;

β

30 to <90%;

χ

10 to <30%;

δ

< 10%.

Changes from pediatric evidence included in 2011 Clinical Practice Guideline:

*

addition;

†

dose revision