Safety Profile of Antiemetic Therapy in Patients Preparing for Hematopoietic Stem Cell Transplantation

Managing Nausea in Patients Preparing for Transplantation

Hematopoietic stem cell transplantation (HSCT) is associated with a high risk of infectious complications. The presence of permanently inserted venous lines also increases the risk of bloodstream infections; hence, oral administration of medications is preferred for these patients.

The oral fixed combination of the 5-HT₃ receptor antagonist palonosetron and the NK₁ receptor inhibitor netupitant (NEPA) is commonly used to suppress chemotherapy-induced nausea and vomiting (CINV) in patients undergoing highly emetogenic chemotherapy. However, there is still limited information regarding the use of this treatment in patients preparing for HSCT. At the annual congress of the European Society for Medical Oncology (ESMO) 2019, a small observational study was presented in the form of a poster, which retrospectively evaluated the safety profile of NEPA in this patient population.

Study Methodology

The study included data from patients with chronic myeloid leukemia, multiple myeloma, myelodysplastic syndrome, and acute myeloid leukemia who underwent allogeneic HSCT between 2017 and 2018. The preparatory regimen consisted of fludarabine and busulfan, with a high dose of cyclophosphamide administered on days 3-4 post-HSCT to prevent graft-versus-host disease.

To prevent CINV, patients received one capsule of NEPA before the preparatory regimen and before cyclophosphamide administration, both times accompanied by oral dexamethasone for 3 days. The incidence of adverse events and the administration of rescue medication (baclofen for hiccups, lactitol, macrogol, or sennosides for constipation relief) were evaluated.

Results and Conclusion

The analysis included 6 patients with a median age of 50 years. All required laxatives, and 2 experienced hiccups necessitating the administration of baclofen. Neutropenic enterocolitis was observed in 5 patients 7 days after chemotherapy administration, but their condition improved with conservative treatment. Oral intake was restricted in 4 patients, with 3 switching completely to parenteral nutrition, and additional antibiotic treatment was initiated in 3 of them. Pain relief medication was administered to 4 patients.

The observed incidence of neutropenic enterocolitis in this study was higher than previously noted in HSCT patients. The potential connection with NEPA administration should be confirmed in larger clinical evaluations.

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Source: Bosch-Damas M., Rodriguez-Reyes M., Cervera-Carbonell M. et al. Safety profile of oral netupitant/palonosetron in hematopoietic stem cell transplantation recipients. Ann Oncol 2019; 30 (suppl_5): v836−v845, doi: 10.1093/annonc/mdz276.