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