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. doi: 10.1007/s00520-014-2248-6. Epub 2014 May 17.

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.

Publication types

  • Clinical Trial, Phase II

MeSH terms

  • Antiemetics / therapeutic use*
  • Aprepitant
  • Female
  • Humans
  • Male
  • Melphalan / administration & dosage
  • Melphalan / adverse effects*
  • Middle Aged
  • Morpholines / therapeutic use*
  • Multiple Myeloma / drug therapy
  • Multiple Myeloma / therapy*
  • Nausea / chemically induced
  • Nausea / prevention & control*
  • Peripheral Blood Stem Cell Transplantation / adverse effects
  • Peripheral Blood Stem Cell Transplantation / methods*
  • Prospective Studies
  • Transplantation Conditioning / adverse effects*
  • Transplantation Conditioning / methods
  • Vomiting / chemically induced
  • Vomiting / prevention & control*

Substances

  • Antiemetics
  • Morpholines
  • Aprepitant
  • Melphalan