Infusion of High Doses of Undiluted Etoposide Through Central Venous Catheters During Preparation for Bone Marrow Transplantation

Abstract

We employed a new method to administer etoposide in high doses to 51 patients undergoing autologous bone marrow transplantation. Undiluted etoposide (20 mg/ml) was sterilely drawn into Luer-Lok plastic syringes, connected to IV extension tubing, and infused intravenously by a syringe pump over 3-4 hours. Patients received etoposide at doses ranging from 400 to 1600 mg/m² per day (median dose: 800 mg). Total actual etoposide doses infused during the transplant period ranged from 2200 to 9000 mg. The infusion rate range was 4.1–13.4 mg/min. No episodes of hypotension, bronchospasm, or hemorrhagic cystitis were noted during or within 3 days of the etoposide infusion. In addition, no cracking of the infusion apparatus was observed in any of the 148 separate infusions. Serum bicarbonate concentrations fell significantly in 6 patients who received the higher etoposide doses. This procedure is superior to the standard method of etoposide drug delivery, since large doses of etoposide may be given without the concomitant administration of large volumes of fluid over short periods of time.