Nausea and vomiting during post-transplantation cyclophosphamide administration

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• Post-transplantation cyclophosphamide (PTCy) is a key strategy for preventing graft-versus-host disease after allogeneic hematopoietic cell transplantation.
• Corticosteroids, commonly used for chemotherapy-induced nausea and vomiting (CINV) prophylaxis, are contraindicated during PTCy due to potential interference with T-cell depletion.
• This limitation poses a challenge for managing CINV in patients receiving PTCy.

Purpose of the Study:

• To evaluate the antiemetic efficacy of a combination regimen comprising a 5-hydroxytryptamine-3 receptor antagonist (5-HT3 RA) and a NK1 receptor antagonist (NK1 RA) in patients undergoing PTCy.
• To compare this efficacy against a similar antiemetic regimen that includes dexamethasone in patients conditioned with cyclophosphamide and total body irradiation (CY/TBI).

Main Methods:

• Retrospective analysis of 36 patients who received PTCy with 5-HT3 RA and NK1 RA combination therapy.
• Comparison with 27 patients who received CY/TBI conditioning with the same combination plus dexamethasone.
• Assessment of the proportion of patients experiencing no vomiting during the acute phase of PTCy administration.

Main Results:

• The proportion of patients who remained free of vomiting during acute PTCy administration was 81%.
• This rate was significantly lower compared to the 100% rate observed in the CY/TBI group (p=0.02).
• The findings indicate that CINV prevention with 5-HT3 RA and NK1 RA alone during PTCy is suboptimal.

Conclusions:

• The combination of 5-HT3 RA and NK1 RA provides suboptimal CINV control in patients undergoing PTCy.
• Additional antiemetic interventions are necessary to effectively manage CINV in this patient population.
• Further research into optimized antiemetic protocols for PTCy is warranted.