Faculty Collaboration Database

Aprepitant for the control of delayed nausea and vomiting associated with the use of high-dose melphalan for autologous peripheral blood stem cell transplants in patients with multiple myeloma: a phase II study. Support Care Cancer 2014 Nov;22(11):2911-6

Date

05/20/2014

Pubmed ID

24838259

DOI

10.1007/s00520-014-2248-6

Scopus ID

2-s2.0-84919385049 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

STUDY OBJECTIVE: The aim of this study is to evaluate the efficacy of aprepitant as part of the antiemetic regimen for high-dose melphalan conditioning in multiple myeloma patients.

DESIGN: This is a prospective, single-arm study.

SETTING: The study was conducted at an Academic Medical Facility.

SUBJECTS: Twenty-six patients receiving high-dose melphalan with autologous stem cell support were included in this study.

INTERVENTION: Eligible patients were >18 years with a diagnosis of MM undergoing high-dose melphalan followed by autologous peripheral blood stem cell transplantation (PBSCT). All patients had serum aminotransferases and total bilirubin less than 2× upper limit of normal. Treatment consisted of aprepitant 125 mg orally on day 1, followed by 80 mg orally 24 and 48 h after the initial dose; ondansetron 16 mg orally day 1; dexamethasone 12 mg orally day 1, and 8 mg orally days 2-4 with breakthrough medications as needed.

MEASUREMENTS AND MAIN RESULTS: Patients were evaluated for the frequency of emetic episodes, the need for breakthrough antiemetic medication, and the mean nausea score in 24-h increments beginning 24 h after chemotherapy and continuing until 120 h. Nausea score was determined using a linear analog scale (0-10). Complete response (CR) was defined as no more than one (1) emetic episode during the evaluation period. A total of 26 patients (17 male, 9 female) were enrolled in the study. Of these, 25 (96 %) were complete responders and 24 (92 %) had no documented emetic episodes during the study period. One patient (4 %) had 1 emetic episode and one patient (4 %) had 2 emetic episodes. Some degree of nausea was reported by 23/26 patients, and the mean nausea score for the entire group over the study period was 0.7 (range 0-10).

CONCLUSIONS: Addition of aprepitant to standard antiemetics resulted in low rates of delayed nausea/vomiting associated with high-dose melphalan and PBSCT, and has now become standard practice in this patient population at our institution.

Author List

Bechtel T, McBride A, Crawford B, Bullington S, Hofmeister CC, Benson DM Jr, Jaglowski S, Penza S, Andritsos LA, Devine SM

Author

Samantha M. Jaglowski MD, MPH Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antiemetics
Female
Humans
Male
Melphalan
Middle Aged
Morpholines
Multiple Myeloma
Nausea
Peripheral Blood Stem Cell Transplantation
Prospective Studies
Transplantation Conditioning
Vomiting