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Prevention of chemotherapy-induced nausea and vomiting after high-dose melphalan and stem cell transplantation: review of the evidence and suggestions

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Abstract

Introduction

High-dose melphalan (HDMel) is the most common conditioning chemotherapy regimen for autologous stem cell transplantation (SCT) in patients affected by multiple myeloma (MM). No consensus exists for the emetogenicity or prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in this regimen.

Methods

Data on the incidence and efficacy/safety of CINV prophylaxis among patients affected by MM undergoing autologous SCT with the HDMel regimen was extracted from electronic databases and analyzed.

Results

Eleven studies involving multiple CINV prophylaxis regimens were identified and included. No consensus on HDMel emetogenicity was reached, but most studies summarized the emetogenicity as moderate-high risk. An aprepitant-based three-drug regimen (aprepitant + serotonin receptor antagonist (5HT3RA) + dexamethasone) showed better efficacy than a two-drug regimen (5HT3RA + dexamethasone) for CINV prevention without increasing the frequency in adverse events.

Conclusions

The aprepitant-based three-drug regimen should be the regimen of choice for CINV prophylaxis for MM patients undergoing autologous SCT with HDMel conditioning.

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Authors and Affiliations

  1. Hematology Division, S. Eugenio Hospital, Piazzale dell’Umanesimo 10, 00144, Rome, Italy

    Andrea Tendas, Luca Cupelli, Pasquale Niscola, Alessio Pio Perrotti & Paolo de Fabritiis

  2. Hematology, Regina Elena National Cancer Institute, Rome, Italy

    Francesco Marchesi & Andrea Mengarelli

  3. Hematology and Stem Cell Transplantation Unit, University Campus Bio-medico, Rome, Italy

    Ombretta Annibali & Valeria Tomarchio

  4. Hematology, San Giovanni-Addolorata Hospital, Rome, Italy

    Debora Saltarelli, Anna Chierichini & Mirko Di Venanzio

  5. Hematology, Sant’Andrea Hospital, Rome, Italy

    Fabio Sollazzo & Monica Piedimonte

  6. Hematology, Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy

    Antoine Bruno, Gottardo De Angelis & William Arcese

  7. Wake Forest University School of Medicine, Winston Salem, NC, USA

    Luciano Delbono

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Correspondence to Andrea Tendas.

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Tendas, A., Marchesi, F., Mengarelli, A. et al. Prevention of chemotherapy-induced nausea and vomiting after high-dose melphalan and stem cell transplantation: review of the evidence and suggestions. Support Care Cancer 27, 793–803 (2019). https://doi.org/10.1007/s00520-018-4594-2

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