Nausea and vomiting during post-transplantation cyclophosphamide administration
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ORIGINAL ARTICLE
Nausea and vomiting during post‑transplantation cyclophosphamide administration Toshihisa Nakashima1 · Yoshihiro Inamoto2 · Ayumu Ito2 · Takashi Tanaka2 · Sung‑Won Kim2 · Takahiro Fukuda2 · Yoshinori Makino1 · Hironobu Hashimoto1 · Masakazu Yamaguchi1 Received: 28 November 2019 / Revised: 16 April 2020 / Accepted: 22 June 2020 © Japanese Society of Hematology 2020
Abstract Post-transplantation cyclophosphamide (PTCy) is a new method to prevent graft-versus-host disease after allogeneic hematopoietic cell transplantation. Although the use of dexamethasone is recommended as prophylaxis against chemotherapyinduced nausea and vomiting (CINV) for patients who receive high-dose cyclophosphamide, corticosteroids cannot be used during PTCy administration to exploit depletion of alloreactive T cells. Thus, CINV may not be adequately controlled in this situation. We retrospectively examined antiemetic efficacy of the combination of a 5-hydroxytryptamine-3 receptor antagonist (5-HT3 RA) and a N K1 receptor antagonist ( NK1 RA) in 36 patients who received PTCy, and compared this efficacy with that of the same combination together with dexamethasone in 27 patients conditioned with cyclophosphamide and total body irradiation (CY/TBI). The proportion of patients who had no vomiting during the acute phase of PTCy administration was 81%, and was lower than 100% in the CY/TBI group (p = 0.02). Our results suggest that prevention of CINV using 5-HT3 RA and N K1 RA during PTCy administration is suboptimal and that addition of antiemetic is necessary in patients who receive PTCy. Keywords Nausea · Vomiting · Post-transplantation cyclophosphamide · Prophylaxis
Introduction Post-transplantation high-dose cyclophosphamide (PTCy) is a new method to prevent graft-versus-host disease (GVHD) following allogeneic hematopoietic cell transplantation (HCT) [1]. The use of PTCy for selective in vivo depletion of alloreactive T cells allows for control of GVHD after T-cell-replete haploidentical HCT [2, 3]. Corticosteroids cannot be used during PTCy administration to exploit depletion of alloreactive T cells. Chemotherapy-induced nausea and vomiting (CINV) is one of most problematic adverse events during cancer chemotherapy [4–8]. In the context of multi-day or highdose chemotherapy, the consensus recommendation for the prophylaxis of CINV was developed by the Multinational
Association of Supportive Care in Cancer /European Society for Medical Oncology [9]. According to this guideline, the recommended prophylaxis against CINV following highdose chemotherapy used for HCT is the combination of a 5-hydroxytryptamine-3 receptor antagonist (5-HT3 RA), a NK1 receptor antagonist (NK1 RA), and dexamethasone. Since we are unable to use dexamethasone in patients who receive the PTCy, CINV may not be adequately controlled in this situation. The aim of this study was to examine the antiemetic efficacy of a combination of 5-HT3 RA and NK1 RA in patients who had PTCy. This efficacy was also compared with that of a combination of
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