Controlling conditioning-related emesis in children undergoing bone marrow transplantation

Area of Science:

• Pediatric Oncology
• Pharmacology
• Hematology

Background:

• Bone marrow transplantation (BMT) conditioning therapy often induces significant nausea and vomiting.
• Effective antiemetic management is crucial for patient comfort and treatment adherence during BMT.
• Current antiemetic strategies require evaluation for optimal efficacy in pediatric BMT patients.

Purpose of the Study:

• To compare the efficacy of ondansetron monotherapy versus a combination of perphenazine and diphenhydramine for controlling emesis in pediatric BMT patients.
• To assess the effectiveness of these antiemetic regimens during the conditioning phase of BMT.

Main Methods:

• A single-center, prospective, randomized, open-label, crossover study was conducted.
• Twenty-eight children (ages 4-17) undergoing BMT were enrolled.
• Emesis control was evaluated based on the number of emetic episodes, with crossover to the alternative regimen if more than five episodes occurred within 12 hours.

Main Results:

• Ondansetron achieved major emesis control (≤2 episodes) in 67% of patients, compared to 0% for perphenazine with diphenhydramine (p=0.044).
• Patients who switched to ondansetron after failing the perphenazine/diphenhydramine regimen showed a 38% rate of major emesis control.
• The incidence of side effects was also monitored for both regimens.

Conclusions:

• Ondansetron demonstrates superior efficacy in controlling therapy-induced emesis compared to perphenazine with diphenhydramine in pediatric BMT patients.
• Oncology nurses should understand antiemetic mechanisms and tailor therapy based on patient response.
• Further research is needed to optimize antiemetic strategies, considering cost-effectiveness and patient-specific needs.