Antiemetic prophylaxis in patients undergoing hematopoietic stem cell transplantation: a multicenter survey of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) transplant programs

Abstract

A survey within hematopoietic stem cell transplant (HSCT) centres of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) was performed in order to describe current antiemetic prophylaxis in patients undergoing HSCT. The multicentre survey was performed by questionnaire, covering the main areas on chemotherapy induced nausea and vomiting (CINV): antiemetic prophylaxis guidelines used, antiemetic prophylaxis in different conditioning regimens, methods of CINV evaluation. The survey was carried out in November 2015 [before the publication of the Multinational Association of Supportive Care in Cancer (MASCC)/ European Society for Medical Oncology (ESMO) specific guidelines on antiemetic prophylaxis in HSCT] and its was repeated six months later. The results show a remarkable heterogeneity of prophylaxis among the various centers and a significant difference between the guidelines and the clinical practice. In the main conditioning regimens, the combination of a serotonin3 receptor antagonist (5-HT3-RA) with dexamethasone and neurokin1 receptor antagonist (NK1-RA), as recommended by MASCC/ESMO guidelines, increased from 0-14% (before the publication of the guidelines) to 10-25% (after the publication of the guidelines). This study shows a lack of compliance with specific antiemetic guidelines, resulting mainly in under-prophylaxis. Concerted strategies are required to improve the current CINV prophylaxis, to draft shared common guidelines and to increase the knowledge and the adherence to the current recommendations for CINV prophylaxis in the specific field of HSCT.

Evaluating the incidence of chemotherapy-induced nausea and vomiting in patients with B-cell lymphoma receiving dose-adjusted EPOCH and rituximab

“…14 Collectively, these data contribute to the growing evidence of CINV outcomes in patients with hematologic malignancies receiving multiday chemotherapy. 10,11,21 Overall, the majority of patients who had documented nausea and/or vomiting experienced these in the delayed phase, 25 to 120 hours after chemotherapy initiation. Increased CINV in the delayed phase compared to the acute phase may be due to the routine administration of a 5HT3 receptor antagonist as this pathway is primarily associated with the acute peripheral pathway of CINV.…”

“…14 Collectively, these data contribute to the growing evidence of CINV outcomes in patients with hematologic malignancies receiving multiday chemotherapy. 10,11,21…”

“…[1][2][3][4] However, many clinicians may be unaware of recent updates to CINV prophylaxis in patients receiving multiday chemotherapy categorized as highly emetogenic. [9][10][11] Although dexamethasone is the most frequently studied corticosteroid for CINV prevention, the use of other corticosteroids, such as methylprednisolone or prednisone, have been described. 12,13 With regard to 5HT3 receptor antagonists, one study has evaluated the use of single-dose palonosetron for antiemetic therapy in patients with non-Hodgkin lymphoma.…”

“…1–4 However, many clinicians may be unaware of recent updates to CINV prophylaxis in patients receiving multiday chemotherapy categorized as highly emetogenic. 9–11…”

Netupitant/palonosetron without dexamethasone for preventing nausea and vomiting in patients with multiple myeloma receiving high-dose melphalan for autologous stem cell transplantation: a single-center experience

“…The problem of controlling CINV in ASCT recipients is far from solved [ 23 ]. The cause of CINV in ASCT is related to many factors, such as gender, age, number of previous chemotherapy lines, and the use of prophylactic antibiotics and narcotic analgesics in the management of mucositis [ 15 , 29 ]. CINV may also be influenced by factors related to treatment including conditioning regimens, administration, dose, duration, and schedule of the drugs, along with the possible additive effect of several chemotherapy drugs [ 27 ].…”