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

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is one of the most frequent adverse events compromising quality of life (QoL) in patients undergoing autologous stem cell transplantation (ASCT). However, CINV prophylaxis is still lacking uniformity for high-dose melphalan (HDM), which is used to condition patients with multiple myeloma (MM). Netupitant/palonosetron (NEPA) is administered with dexamethasone (DEXA) for CINV prevention in several chemotherapy regimens. Our study aims to assess the efficacy of NEPA, without DEXA, in preventing CINV in 106 adult patients with MM receiving HDM and ASCT. All patients had antiemetic prophylaxis with multiple doses of NEPA 1 h before the start of conditioning and after 72 h and 120 h. A complete response (CR) was observed in 99 (93%) patients at 120 h (overall phase). The percentage of patients with complete control was 93%. The CR rate during the acute phase was 94% ( n = 100). During the delayed phase, the CR rate was 95% ( n = 101). Grade 1 nausea and vomiting were experienced by 82% and 12% of the patients, respectively. Grade 2 nausea was reported in 18% and vomiting in 10% of patients. Our results showed, for the first time, that NEPA, without DEXA, was a well-tolerated and effective antiemetic option for MM patients receiving HDM followed by ASCT. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06472-7.

Comparison of netupitant/palonosetron with 5-hydroxytryptamine-3 receptor antagonist in preventing of chemotherapy-induced nausea and vomiting in patients undergoing hematopoietic stem cell transplantation

“…The findings from both studies indicated that the majority of patients did not experience emesis during both the acute and delayed phases (13,14). Another observational study reported the effectiveness of multidose NEPA during high-dose melphalan chemotherapy, with an impressive 93.3% of patients achieving CR (15). It is worth noting that the aforementioned studies utilized a three-dose regimen of NEPA.…”

“…Two phase II clinical trials investigated the use of NEPA in patients receiving BEAM (carmustine + etoposide + cytarabine + melphalan) or FEAM (fotemustine + etoposide + cytarabine + melphalan) chemotherapy (13, 14). Additionally, two observational studies described its effectiveness during high-dose melphalan chemotherapy (15,16). However, these studies primarily focused on specific chemotherapy regimens, which may not adequately represent the diverse and complex conditioning regimens used prior to HSCT, particularly those involving multiday high-dose chemotherapy.…”

Сопроводительная Терапия При Множественной Миеломе: Практические Рекомендации

“…В связи с этим в комбинации с апрепитантом доза дексаметазона должна быть снижена приблизительно на 50 %. У пациентов, получающих варфарин, необходимо дополнительно контролировать уровень МНО [87][88][89][90][91][92]. Антагонисты NK1-рецепторов применяют в комбинации с ГКС и антагонистами 5-НТ3-рецепторов.…”

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

“…In adults, the use of a dexamethasone-free approach consisting in the administration of a netupitant-palonosteron combination or in the substitution of dexamethasone with olanzapine was shown to have similar efficacy as the use of dexamethasone; however, prospective data are awaited for children [43].…”