Outcomes of antiemetic prophylaxis in children undergoing bone marrow transplantation

Area of Science:

• Pediatric Oncology
• Hematology
• Clinical Pharmacology

Background:

• Bone marrow transplantation (BMT) involves intensive chemotherapy and radiation.
• Nausea and vomiting are common, distressing side effects in pediatric BMT patients.
• Effective control of these symptoms is crucial for patient well-being and treatment adherence.

Purpose of the Study:

• To prospectively evaluate the control of acute and delayed nausea and vomiting in children undergoing BMT.
• To identify factors influencing the efficacy of antiemetic regimens.
• To assess the success of current antiemetic strategies in this pediatric population.

Main Methods:

• A prospective survey was conducted at The Hospital for Sick Children.
• Data collected included patient demographics, pre-treatment factors, conditioning regimens, and antiemetic use.
• Emesis, nausea, dietary intake, and adverse effects were monitored daily during conditioning and for 96 hours post-treatment.
• Children over 3 years old self-reported nausea levels.

Main Results:

• Twenty-five children were monitored over 258 patient days.
• Vomiting or retching was absent on 73% of acute phase and 43% of delayed phase patient days.
• Nausea was absent on 55% of acute phase and 26% of delayed phase patient days.
• Five children experienced no emetic episodes, and one child had no nausea or vomiting throughout the study.

Conclusions:

• Antineoplastic and radiation-induced nausea and vomiting are largely preventable in pediatric BMT patients.
• Effective antiemetic strategies can significantly improve patient outcomes.
• Further development of treatment strategies is needed for antiemetic failure and for patients unable to tolerate dexamethasone.