title: 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.
abstract: BACKGROUND
  The current standard for prevention of chemotherapy-induced nausea/vomiting in autologous stem cell transplant only achieves 4-20% emetic control.
  
  
  OBJECTIVE
  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.
authors.affiliation: Hematology/Oncology, UC San Diego Nevada Cancer Institute, Las Vegas, NV, USA.
authors.forename: Delva
authors.initials: D
authors.lastname: Deauna-Limayo
authors.affiliation: Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS, USA oaljitawi@kumc.edu.
authors.forename: Omar S
authors.initials: OS
authors.lastname: Aljitawi
authors.affiliation: Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Abhyankar
authors.affiliation: Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Jo A
authors.initials: JA
authors.lastname: Wick
authors.affiliation: Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McGuirk
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D000077608:Aprepitant; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007546:Isoquinolines / Q000008:administration & dosage*; D008223:Lymphoma / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D000077924:Palonosetron; D010865:Pilot Projects; D011788:Quality of Life; D011812:Quinuclidines / Q000008:administration & dosage*; D014182:Transplantation, Autologous; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D007546:Isoquinolines; D009025:Morpholines; D011812:Quinuclidines; D000077608:Aprepitant; D000077924:Palonosetron; D003907:Dexamethasone
keywords: Aprepitant; autologous hematopoietic stem cell transplant; chemotherapy-induced nausea and vomiting; multiday palonosetron