9055 Background: Ifosfamide (IFO) is very effective and widely used in pediatric oncology protocols. Patients are usually admitted to receive IFO infusions due to potential urological and neurological complications. The current study was conducted to assess the feasibility of outpatient IFO infusions in children and adolescents with cancer, the compliance of the patients and their parents, and the acute toxicities in this setting. Methods: All patients with newly diagnosed solid tumors included in protocols with at least three cycles of IFO/mesna were eligible for this study. IFO was administered I.V. over one hour. Doses varied according to the underlying malignancy and protocol from 2.5–3.0g/m2/day × 3 days to 2.7g/m2/day × 5 days. Three doses of mesna were administered intravenously in the outpatient clinic at 75% of the IFO dose divided on hours 0, 3 and 6 and a fourth dose of mesna was given as oral tablets at home 12 hours after IFO. Hydration was 2L/m2 I.V. over 5 hours in the hospital, followed by another 1L/m2 P.O. at home. Kidney function was assessed before, during, and after treatment through glomerular filtration rate; sodium, magnesium, calcium, uric acid renal excretions; urinary phosphate threshold and retinol-binding protein. Results: From November 2003 to August 2005, 30 patients received a total of 160 IFO cycles. Compliance was 100%. The incidence of grades 3 and 4 toxicities in all IFO cycles was: gastrointestinal 15%, leucopenia 92%, neutropenia 88%, thrombocytopenia 29%, hepatotoxicity 3%, and genitourinary 7%. No patient had gross hematuria, neurotoxicity or had to be admitted for chemotherapy. One third of the patients developed subclinical tubular nephropathy. Conclusions: Ambulatory infusion of IFO is safe and toxicities are comparable to the expected with inpatient administration. No significant financial relationships to disclose.
