Controlling conditioning-related emesis in children undergoing bone marrow transplantation.

PURPOSE/OBJECTIVES: To compare the efficacy of two antiemetic regimens, ondansetron alone versus perphenazine with diphenhydramine, on emesis control in children undergoing conditioning therapy for bone marrow transplantation (BMT). DESIGN: Single-center, prospective, open, randomized, crossover study. SETTING: Pediatric BMT unit in an urban area in the northeastern United States. SAMPLE: 28 children, ages 4-17, undergoing BMT for a variety of underlying diseases. METHODS: After randomization to one of the two antiemetic regimens, emesis control was evaluated during conditioning therapy. If a participant experienced more than five episodes of emesis during any 12-hour period, he or she was crossed over to the other antiemetic regimen. If emesis control still was not achieved, the participant was removed from the study and other medications were administered to control vomiting. MAIN RESEARCH VARIABLES: Number of emetic episodes and incidence of side effects. FINDINGS: 10 of 15 patients (67%) who received ondansetron experienced major emesis control (no more than two episodes) compared with 0 of 13 patients (0%) who received perphenazine with diphenhydramine (p = 0.044, Fisher exact test). Of those who crossed over to ondansetron after failure with perphenazine and diphenhydramine, 38% were able to achieve major emesis control. CONCLUSIONS: Ondansetron offers superior antiemetic control over the combination of perphenazine and diphenhydramine for children undergoing high-dose chemotherapy with or without total body irradiation for BMT. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must develop an understanding of the etiology of therapy-induced emesis and the mechanisms of action of the various classes of antiemetic agents designed to control it. Implementing documentation to describe events of emesis will help to tailor antiemetic therapy to a patient's specific situation. Further research is necessary to determine alternate strategies, including different combinations or sequences of antiemetics to provide optimum emetic control during acute and delayed phases of emesis. The higher cost of ondansetron therapy must be considered within the context of superior efficacy.

Growth inhibition of malignant CD5+B (B-1) cells by antisense IL-10 oligonucleotide.

Malignant B-1 cells derived from NZB mice, a murine model of chronic lymphocytic leukemia, produce significantly higher levels of IL-10 mRNA than normal B-1 or B cells. IL-10 may act as an autocrine growth factor for malignant B-1 cells. By addition of antisense oligodeoxynucleotides specific for IL-10 mRNA, we were able to dramatically inhibit the growth of leukemic B-1 cells in a time and dose dependent manner. Control cell lines which do not depend on IL-10 for growth were not affected. Antisense therapy targeted at the 5' region of the IL-10 mRNA not only resulted in inhibition of malignant B-1 cell proliferation but also inhibited IL-10 production by malignant B-1 cells. Because endogenous IL-10 gene activation is critical for B-1 cell expansion, inactivation of the endogenous IL-10 gene by IL-10 antisense rather than extracellular regulation of the IL-10 gene product should be successful in controlling the malignant growth.

Day care services: an alternative to institutional care.

The day care program at St. Camillus Nursing Home in Syracuse, New York is described. The growth rate of the program,, the observed benefits to the participants, and acceptance by their family members indicate its value to the community. The admission criteria are well defined and non-restrictive, and there is a wide scope of services. However, a greater number of participants and expansion of the services would be feasible if Medicare patients could be included in the program besides the present Medicaid and private physician referrals. Such reimbursement should be provided for the sake of participants and their families, as well as for the economics of the total health structure. This would open the doors for day care programs in many other communities across the nation.