Methods:
After institutional review board approval, etoposide infusion related
ADRs were retrospectively evaluated from January 1, 2010 - July 31, 2020
at Children’s Mercy Hospital (CMH), Kansas City, MO, and Riley Hospital
for Children (RH), Indianapolis, IN. Both institutions identified
etoposide ADRs using multiple detection methods including ADRs entered
into the electronic medical record (EMR), international classification
of disease (ICD)-9 and ICD-10 codes for anaphylaxis, flushing, rash, or
hypotension, orders for diphenhydramine, hydrocortisone, or epinephrine
within 24 hours of etoposide dose, and orders for etoposide phosphate as
this formulation is used when patients have had an etoposide ADR. These
triggers prompted manual EMR review to collect data related to the ADR.
Both institutions used a standard etoposide concentration of 0.4mg/mL.
In-line filter use was standard protocol at CMH starting late 2017, and
no filters were used at RH. Etoposide was infused over 1hr and 2hr at
CMH and RH respectively, but could be modified by providers. A modified
Hartwig’s Severity Assessment Tool was used to classify ADR severity
(TABLE 1).8,9