Use of palonosetron 0.25 mg IV daily and incidence of nausea and vomiting in patients undergoing bone marrow transplantation (BMT)

Abstract

16510 Background: Preparative regimens for BMT are associated with a high incidence of nausea and vomiting, which can negatively affect quality of life. It is important to evaluate the incidence of nausea and vomiting and understand which antiemetic regimens are most effective in these patients in order to improve outcomes. Methods: A retrospective review of patients admitted to the adult BMT Unit at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1/1/05 and 12/31/05 was performed. Currently at MSKCC, palonosetron (0.25 mg IV daily) is used as the main antiemetic agent during the preparative regimen; dexamethasone 20 mg IV is occasionally combined with palonosetron when there is no other contraindication to its use with some preparative regimens. The electronic medical records, as well as the pharmacy computer system, were used to collect demographics, primary diagnosis, BMT type, preparative BMT regimen, days of regimen, whether radiation was included, antiemetic used, and incidence of nausea and vomiting, which were assessed 3 times daily during the administration of the preparative regimen. Results: 176 pts (75 women, 101 men) received BMT; mean age was 50 yrs (18–73). All patients received a highly emetogenic preparative regimen for which the mean duration was 5 days (1–9 days). Over a 1–12 day period the incidence of nausea and vomiting were 78% and 39% in those undergoing an allogeneic transplant compared with 51% and 18% in those undergoing an autologous transplant. Patients with leukemia had the highest incidence of nausea (85%) and vomiting (45%). The rates of nausea and vomiting in those receiving radiation were 81% and 33%, while in those not receiving radiation, the rates of nausea and vomiting were 51% and 20%, respectively. Of patients receiving palonosetron alone, 87% experienced nausea and 41% had vomiting, compared to 48% and 15% for those receiving both palonosetron and dexamethasone. Conclusions: Radiation therapy and allogeneic transplant had higher incidences of nausea and vomiting when compared to autologous transplant. Nausea and vomiting were better controlled in patients receiving palonosetron and dexamethasone compared with those receiving palonosetron alone. No significant financial relationships to disclose.