Negar Shavandi, Paula D. Robinson, Shana Jacobs, L. Lee Dupuis, the International Pediatric Dexamethasone Panel
BACKGROUND: An international Delphi panel of experts developed consensus statements to delineate the circumstances where the risks of dexamethasone as an antiemetic do and do not outweigh its benefits. PROCEDURE: Experts in supportive care of pediatric patients were invited to participate. Using Delphi methods, the study was conducted as four electronic surveys and three virtual meetings. In Survey 1, panelists provided demographic information and described institutional practices regarding dexamethasone use in chemotherapy-naïve pediatric patients receiving moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC). In Surveys 2-4, panelists indicated their beliefs regarding the risks versus benefits of dexamethasone as an antiemetic in chemotherapy-therapy-naïve patients about to receive MEC or HEC in various scenarios. Evidence regarding the risks of dexamethasone was discussed at each virtual meeting, together with the survey results. Consensus was defined as occurring when at least 75% of panelists responded, and 80% of respondents agreed. RESULTS: Sixteen panelists participated. Consensus was achieved that the benefits of dexamethasone as an antiemetic outweigh its risks in pediatric patients with bone tumors, germ cell tumors (other than central nervous system), hepatoblastoma, retinoblastoma, or rhabdomyosarcoma or in pediatric patients undergoing autologous hematopoietic stem cell transplant. Consensus was also achieved that the benefits of dexamethasone as an antiemetic do not outweigh its risks in pediatric patients undergoing chimeric receptor antigen T-cell therapy or with known fungal infection. CONCLUSIONS: The consensus statements of the Delphi panel provide guidance on dexamethasone use as an antiemetic in chemotherapy-naïve pediatric patients receiving MEC or HEC.