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

Delva Deauna-Limayo, Omar S. Aljitawi, Siddhartha Ganguly, Sunil Abhyankar, Jo A. Wick, Joseph P. McGuirk

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: The current standard for prevention of chemotherapy-induced nausea/vomiting in autologous stem cell transplant only achieves 4-20% emetic control. Objectives: To assess emetic responses to multiday palonosetron, aprepitant, and low-dose dexamethasone among patients with myeloma and lymphoma undergoing autologous hematopoietic stem cell transplant. Methods: Oral aprepitant 125/80/80 mg was administered with intravenous dexamethasone 4 mg and palonosetron 0.25 mg on days -3, -2, -1 for multiple myeloma and days -7 through -3 for lymphoma. Palonosetron was repeated day +3 in both groups. Results: A total of 20 patients were enrolled and 18 analyzed. None experienced emetic failure with complete control achieved in 78, 33, and 17% in the acute, delayed, and extended phases, respectively. Nausea occurred in 78% although not significant in 61%, with median Nausea Visual Score of 4.5. Quality of life correlated with emetic and nausea control. Eight patients developed grade 2-3 nonhematologic toxicities with only one event attributed to the study medications. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)263-269
Number of pages7
JournalJournal of Oncology Pharmacy Practice
Volume20
Issue number4
DOIs
StatePublished - Aug 2014

Keywords

  • Aprepitant
  • Autologous hematopoietic stem cell transplant
  • Chemotherapy-induced nausea and vomiting
  • Multiday palonosetron

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)

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