Combined use of multiday palonosetron with aprepitant and low-dose dexamethasone in prevention of nausea and emesis among patients with multiple myeloma and lymphoma undergoing autologous hematopoietic stem cell transplant: A pilot study

Abstract

This triplet regimen was feasible with acceptable safety profile in the autologous hematopoietic stem cell transplant setting. Emetic control was best achieved in the acute phase. Lesser degree of emetic and nausea control in the delayed and extended phases impacted quality of life. Our results warrant further evaluation in a larger autologous hematopoietic stem cell transplant population.

Prevention of chemotherapy-induced nausea and vomiting after high-dose melphalan and stem cell transplantation: review of the evidence and suggestions

“…Four detailed articles [11][12][13][14] evaluating the acute emetogenicity of HDMel in patients undergoing CINV prophylaxis with different schedules reported a low emesis incidence (0-41%). Other research on HDMel reported delayed vomiting as moderately frequent (12-66%), despite adequate prophylaxis [11,[13][14][15][16]. Finally, our analysis of the literature showed a similar rate of CINV in the two melphalan schedules (MEL200×1 and MEL100×2).…”

“…Eleven papers, reporting results of clinical trials, that explored the effectiveness of a certain prophylaxis for CINV in patients undergoing HDMel conditioning for autologous SCT are included (Table 1). Of these 11 studies, 2 are randomized, comparative, and prospective [7,18], 6 are single-arm prospective [7,12,15,16,18,20], 2 are comparative and retrospective [10,19], and 1 is single-arm retrospective [13] ( Table 1). From these experiments, only aprepitant, fosaprepitant, and olanzapine were compared to standard therapy in the setting of HDMel.…”

“…The six noncomparative, single-arm, prospective studies [7,12,15,16,18,20] investigated the efficacy of an aprepitant-containing three-drug regimen (four studies [12,15,16,20]), a fosaprepitant-containing three-drug regimen (one study [18]), and a palonosetron-containing two-drug regimen (one study [7]). The results disclosed a high probability of protection from emesis with rescue medication (80-88%) and a lower, although different between trials, probability of protection from emesis without rescue medication (0-52%).…”

“…No trials compared the efficacy of different 5HT3RAs in the setting of HDMel. When analyzing the data of the five trials [7,11,13,15,20] in which palonosetron was used as an 5HT3RA in a two or three-drug regimen, it is impossible to decipher the difference with the other 5HT3RAs (Table 1).…”

“…5HT3RA 5HT3RAs are recommended by guidelines for CINV prophylaxis in autologous SCT, as well as for highly emetogenic drugs as part of a three-drug combination (aprepitant + 5HT3RA + dexamethasone) [4,8,9]. In the setting of HDMel, palonosetron was investigated in five trials [7,11,13,15,20], granisetron in three trials [12,17,19], and ondansetron in three trials [14,16,18]. The efficacy of different 5HT3RA drugs was not evaluated in the setting of HDMel; therefore, they should perhaps be considered equivalent in terms of efficacy for CINV prevention.…”