Perreault Sarah, Baker Julie, Medoff Erin, Pratt Kathryn, Foss Francine, Isufi Iris, Seropian Stuart, Cooper Dennis L
Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA.
Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA.
Support Care Cancer. 2017 Jan;25(1):205-208. doi: 10.1007/s00520-016-3399-4. Epub 2016 Sep 10.
Carmustine (BCNU) is used in the conditioning regimens BEAM and CBV for autologous stem cell transplantation. Carmustine-related infusion reactions, while not described in the BEAM literature, occurred in 95 % of patients who received CBV. The most common symptoms include flushing, facial pain, headache, and hypotension. These reactions have been attributed to the absolute ethanol that is used in the reconstitution process or alternatively by a direct effect of carmustine. It is currently recommended that carmustine 300 mg/m be infused over at least 100 min (3-5 mg/m/min). Prior to October 2014, carmustine infusions were given over 90 min but were changed to 120 min based on the above recommendation. We compared the two infusion rates in patients receiving BEAM to see if lengthening the infusion decreased the frequency of reactions.
Overall, 100 patients received BCNU as part of BEAM or Zevalin BEAM and were equally divided between 90 and 120 min infusion times. The primary outcome was the incidence of infusion-related reactions which were graded based on CTCAE 4.03 descriptions of flushing and infusion-related reactions. We also evaluated the impact of premedication as well as the efficacy of medications used to treat infusion reactions.
Between the years 2013-2016, there were 50 patients who received BCNU over 90 min and 50 patients over 120 min. There were no significant differences observed for diagnosis, age and gender between the two groups. Twenty-eight (56 %) in the 90-min and 26 (52 %) in the 120-min infusion intervals developed a reaction (p = 0.6882). Of the patients that developed a reaction, 19 patients (67 %) in the 90-min and all 26 patients (100 %) in the 120-min infusion were given premedications predominately acetaminophen, in addition to dexamethasone. Among reacting patients, 57 % of the 90-min and 65 % of the 120-min groups received additional intervention (p = 0.53).
Infusion reactions during high-dose BCNU are common and are not clearly reduced by modestly extending the duration of infusion or giving premedications.
卡莫司汀（BCNU）用于自体干细胞移植的预处理方案BEAM和CBV中。虽然BEAM相关文献中未描述与卡莫司汀相关的输注反应，但在接受CBV的患者中，95%出现了此类反应。最常见的症状包括潮红、面部疼痛、头痛和低血压。这些反应被认为是由于复溶过程中使用的无水乙醇，或者是卡莫司汀的直接作用。目前建议卡莫司汀300mg/m²至少在100分钟内输注完毕（3 - 5mg/m²/分钟）。2014年10月之前，卡莫司汀输注时间为90分钟，但根据上述建议改为120分钟。我们比较了接受BEAM方案的患者的两种输注速率，以观察延长输注时间是否会降低反应频率。
总体而言，100例患者接受BCNU作为BEAM或Zevalin BEAM方案的一部分，且在90分钟和120分钟输注时间组中平均分配。主要结局是输注相关反应的发生率，根据CTCAE 4.03对潮红和输注相关反应的描述进行分级。我们还评估了预处理的影响以及用于治疗输注反应的药物的疗效。
在2013 - 2016年期间，50例患者在90分钟内接受BCNU输注，50例患者在120分钟内接受输注。两组在诊断、年龄和性别方面未观察到显著差异。90分钟输注组中有28例（56%）出现反应，120分钟输注组中有26例（52%）出现反应（p = 0.6882）。在出现反应的患者中，90分钟输注组的19例患者（67%）和120分钟输注组的所有26例患者（100%）除地塞米松外，主要接受了对乙酰氨基酚预处理。在有反应的患者中，90分钟组的57%和120分钟组的65%接受了额外干预（p = 0.53）。
大剂量BCNU输注期间的输注反应很常见，适度延长输注时间或进行预处理并不能明显降低反应发生率。
