When would you use dexamethasone-free antiemetic prophylaxis with olanzapine in pediatric patients receiving highly emetogenic chemotherapy?

At our institution, our leukemia/lymphoma, bone marrow transplant, and neuro-oncology providers generally do not feel comfortable with the use of dexamethasone for the prevention of CINV in their patients. In addition, neuroblastoma patients receiving dinutuximab also do not receive dexamethasone. T...

Why decadron-free? If it's a single small dose, such as 2 mg or 4 mg given with Emend (and omeprazole) - I find that works incredible well even for high dose oxaliplatin. I would not worry about a single dose changing the BBB or influencing treatment to the same degree that NV can change treatment.