Olanzapine Reduces Chemotherapy-induced Nausea and Vomiting Compared With Aprepitant in Myeloma Patients Receiving High-dose Melphalan Before Stem Cell Transplantation: A Retrospective Study

Steven Trifilio*, Colleen Welles, Kristin Seeger, Shivani Mehta, Mary Anne Fishman, Katherine McGowan, Kathryn Strejcek, Emily Eiten, Carolyn Pirotte, Elizabeth Lucier, Sean DeFrates, Jayesh Mehta

*Corresponding author for this work

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is common in patients who receive high-dose melphalan as a conditioning regimen before autologous hematopoietic stem cell transplantation. With suboptimal CINV control using an aprepitant-based antiemetic regimen, we switched to an olanzapine-based regimen. We performed a retrospective study to compare these 2 regimens and found significant improvement in acute and delayed nausea control and a reduction in the use of CINV rescue medications. Introduction Acute and delayed chemotherapy-induced nausea and vomiting (CINV) occurs in most patients who receive high-dose melphalan and significantly affects patients' quality of life during autologous stem cell transplantation. Faced with unsatisfactory results using an aprepitant-based regimen, an olanzapine-based regimen was initiated, with the hope of improving the incidence of acute and delayed CINV. A retrospective study was conducted to compare the effectiveness of olanzapine- versus aprepitant-based regimens for CINV prevention in adult hematopoietic stem cell recipients who received high-dose melphalan. Patients and Methods We compared olanzapine (n = 43) to aprepitant (n = 54) and fosaprepitant (n = 20). Olanzapine was given orally at 5 mg twice daily for 5 days, aprepitant was given at 125 mg on day −1 and 80 mg on days 0 and 1, and fosaprepitant was given at 150 mg on day −1. The dose of 2 concomitant drugs (dexamethasone and 5-hydroxytryptamine type 3 receptor antagonist) was similar in the 2 groups. Nausea prevention was the primary endpoint. A complete response using a composite index of no emesis and no use of rescue medications was the secondary endpoint. Results The results showed that olanzapine significantly reduced the number of patients who experienced acute (P < .0001) or delayed (P < .004) nausea and significantly reduced the use of rescue medications for acute-onset (P < .0046) and delayed-onset (P < .0001) CINV compared with aprepitant. Conclusion Compared with fosaprepitant, olanzapine reduced the number of patients with acute (P < .0318) and delayed (P < .1519) nausea and reduced the need for rescue medications for acute-onset (P < .0643) and delayed-onset (P < .0024) CINV.

Original languageEnglish (US)
Pages (from-to)584-589
Number of pages6
JournalClinical Lymphoma, Myeloma and Leukemia
Volume17
Issue number9
DOIs
StatePublished - Sep 1 2017

Keywords

  • Autograft
  • Chemotherapy
  • Emesis
  • Prevention
  • Protracted CINV

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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