title: Prevention of nausea and vomiting associated with stem cell transplant: results of a prospective, randomized trial of aprepitant used with highly emetogenic preparative regimens.
abstract: Uncontrolled delayed nausea and vomiting remains a problem after high-dose preparative regimens used for autologous and allogeneic hematopoietic stem cell transplants. Recently, aprepitant was approved for highly and moderately emetogenic chemotherapy, and, in particular, is effective for decreasing delayed emesis. To evaluate its safety and efficacy in the transplantation setting, we performed a randomized, placebo-controlled, phase 3 trial of aprepitant in combination with ondansetron and dexamethasone in patients treated with ablative preparative regimens. Patients were randomized to receive oral aprepitant or placebo daily with oral ondansetron and dexamethasone during and for 3 days after the completion of the preparative regimen in this prospective randomized, double-blind study. The primary objective was complete response (CR) rate, defined as no emesis with no or mild nausea. Other endpoints included number of emetic episodes, nausea severity assessed using a 100-mm visual analog scale (VAS), the need for rescue antiemetics, and transplantation outcome, including regimen-related toxicity. One hundred eighty-one patients were randomized and 179 patients were eligible for analysis. Overall, CR rates were 81.9% for the aprepitant and 65.8% for the placebo arms (P < .001). Percentages of patients with no emesis all days were 73.3% for aprepitant and 22.5% placebo (P < .001). Mean VAS scores were 16.6 mm aprepitant and 16.9 mm placebo (NS), and there were no differences in the amount of rescue antiemetics used, regimen related toxicity, engraftment, or transplantation outcome. Aprepitant in combination with dexamethasone and ondansetron significantly decreased emesis and significant nausea, whereas not increasing RRT or affecting short-term survival but had no significant impact on the use of PRN antiemetics, or overall VAS nausea scores.
authors.affiliation: Bone Marrow Transplant Program, Department of Pharmacy, University Medical Center, Maywood, Illinois, USA. pstiff@lumc.edu
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Stiff
authors.forename: Mary P
authors.initials: MP
authors.lastname: Fox-Geiman
authors.forename: Karen
authors.initials: K
authors.lastname: Kiley
authors.forename: Karen
authors.initials: K
authors.lastname: Rychlik
authors.forename: Mala
authors.initials: M
authors.lastname: Parthasarathy
authors.forename: Donna
authors.initials: D
authors.lastname: Fletcher-Gonzalez
authors.forename: Nancy
authors.initials: N
authors.lastname: Porter
authors.forename: Aileen
authors.initials: A
authors.lastname: Go
authors.forename: Scott E
authors.initials: SE
authors.lastname: Smith
authors.forename: Tulio E
authors.initials: TE
authors.lastname: Rodriguez
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage* / Q000009:adverse effects; D000077608:Aprepitant; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage* / Q000009:adverse effects; D017294:Ondansetron / Q000008:administration & dosage / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D000932:Antiemetics; D009025:Morpholines; D000077608:Aprepitant; D017294:Ondansetron; D003907:Dexamethasone