Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kaufman J, Lonial S (2004) Multiple myeloma: the role of transplant and novel treatment strategies. Semin Oncol 31(suppl 4):99–105

    Article  PubMed  CAS  Google Scholar 

  2. Jemal A, Tiwari RC, Murray T et al (2004) Cancer statistics: 2004. Ca Cancer J Clin 54:8–29

    Article  PubMed  Google Scholar 

  3. Sirohi B, Powles R (2004) Multiple myeloma. Lancet 363:875–887

    Article  PubMed  Google Scholar 

  4. Gasparaetto C (2004) Stem cell transplantation for multiple myeloma. Cancer Control 11:119–129

    Google Scholar 

  5. Hesketh PJ, Kris MG, Grunberg SM et al (1997) JCO 15:103–109

    CAS  Google Scholar 

  6. Lopez-Jimenez J, Martin-Ballestros E, Sureda A et al (2006) Chemotherapy-induced nausea and vomiting in acute leukemia and stem cell transplant patients: results of a multicenter, observational study. Haematologica 91:84–91

    PubMed  CAS  Google Scholar 

  7. Abbott B, Ippoliti C, Hecth D et al (2000) BMT 25:1279–1283

    CAS  Google Scholar 

  8. DeMulder PH, Seynaeve C, Vermorken JB et al (1990) Ondansetron compared with high-dose metoclopramide in prophylaxis of acute and delayed cisplatin-induced nausea and vomiting. A multicenter, randomized, double-blind, crossover study. Ann Intern Med 113:834–840

    Article  CAS  Google Scholar 

  9. Curran MP, Robinson DM (2009) Aprepitant: a review of its use in the prevention of nausea and vomiting. Drugs 69:1853–1878

    Article  PubMed  CAS  Google Scholar 

  10. Hesketh PJ, Grunberg SM, Gralla RJ et al (2003) The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin—the Aprepitant Protocol 052 Study Group. J Clin Oncol 21:4112–4119

    Article  PubMed  CAS  Google Scholar 

  11. Warr DG, Hesketh PJ, Gralla RJ et al (2005) Efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer after moderately emetogenic chemotherapy. J Clin Oncol 23:2822–2830

    Article  PubMed  CAS  Google Scholar 

  12. Schmoll HJ, Aapro MS, Poli-Bigelli S et al (2006) Comparison of an aprepitant regimen with a multiple-day ondansetron regimen, both with dexamethasone, for antiemetic efficacy in high-dose cisplatin treatment. Ann Oncol 17:1000–6

    Article  PubMed  CAS  Google Scholar 

  13. Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS. 2003. National Cancer Institute. 16 Dec. 2004. http://ctep.cancer.gov/forms/CTCAEv3.pdf

  14. Bliss JM, Robertson B, Selby PJ (1992) The impact of nausea and vomiting upon quality of life measures. Br J Cancer Suppl 19:S14–S22

    PubMed  CAS  PubMed Central  Google Scholar 

  15. Ballen KK, Hesketh AM, Heyes C et al (2001) Prospective evaluation of antiemetic outcome following high-dose chemotherapy with hematopoietic stem cell support. Bone Marrow Transplant 28:1061–1066

    Article  PubMed  CAS  Google Scholar 

  16. Basch E, Prestrud AA, Hesketh PJ et al (2011) Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 29:4189–4198

    Article  PubMed  Google Scholar 

  17. Paul B, Trovato JA, Thompson J, Badros AZ, Goloubeva O (2010) Efficacy of aprepitant in patients receiving high-dose chemotherapy with hematopoietic stem cell support. J Oncol Pharm Pract 16(1):45–51

  18. Szer J, Grigg AP, Roberts AW et al (2006) Aprepitant in the prevention of acute and delayed nausea and vomiting following haemopoietic stem cell transplantation: a pilot study. 32nd Annual Meeting of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 37(Suppl 1)

  19. Barnett CM, Oholendt MS, Popat U et al (2004) Evaluation of aprepitant for treatment of acute and delayed chemotherapy-induced nausea and vomiting in patients undergoing autologous stem cell transplantation. Blood 104: 343b (abstract no. 5041)

  20. Stiff PJ, Fox-Geiman MP, Kiley K et al (2013) Prevention of nausea and vomiting associated with stem cell transplant: results of a prospective, randomized trial of aprepitant used with highly emetogenic preparative regimens. Biol Blood Marrow Transplant 19:49–55

    Article  PubMed  CAS  Google Scholar 

  21. Sanchez RI, Wang RW, Newton DJ et al (2004) Cytochrome P450 3A4 is the major enzyme involved in the metabolism of the substance P receptor antagonist aprepitant. Drug Metab Dispos 32:1287–92

    Article  PubMed  CAS  Google Scholar 

  22. de Jonge ME, Huitema AD, Holtkamp MJ et al (2005) Aprepitant inhibits cyclophosphamide bioactivation and thiotepa metabolism. Cancer Chemother Pharmacol 56:370–8

    Article  PubMed  Google Scholar 

  23. Egerer G, Eisenlohr K, Gronkowski M et al (2010) The NK1 receptor antagonist aprepitant does not alter the pharmacokinetics of high-dose melphalan chemotherapy in patients with multiple myeloma. Br J Clin Pharmacol 70:903–7

    Article  PubMed  CAS  PubMed Central  Google Scholar 

Download references

Conflict of interest

The authors report no conflict of interest in the design, development, or editing of the manuscript.

Author information

Authors and Affiliations

  1. The University of Arizona Cancer Center, Tucson, AZ, 85719, USA

    Ali McBride

  2. Stem Cell Transplant, Arthur G. James Cancer Hospital, The Ohio State University, Columbus, OH, USA

    Thomas Bechtel

  3. Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Craig C. Hofmeister, Don M. Benson Jr, Samantha Jaglowski, Sam Penza, Leslie A. Andritsos & Steven M. Devine

  4. Department of Pharmacy, Arthur G. James Cancer Hospital, University of Arizona Cancer Center, 3838 N Campbell Ave, Tucson, AZ, 85719, USA

    Ali McBride

  5. Roudebush VA Medical Center, Indianapolis, IN, USA

    Brooke Crawford & Susan Bullington

Authors
  1. Thomas Bechtel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ali McBride
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brooke Crawford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Bullington
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Craig C. Hofmeister
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Don M. Benson Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Samantha Jaglowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sam Penza
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Leslie A. Andritsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Steven M. Devine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali McBride.

Additional information

Presented in part at the 2008 American Society of Bone Marrow Transplantation, February 7–13, 2008, San Diego, California.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bechtel, T., McBride, A., Crawford, B. et al. 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 22, 2911–2916 (2014). https://doi.org/10.1007/s00520-014-2248-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-014-2248-6

Keywords

Search

Navigation