Effectiveness of antiemetic regimens in controlling chemotherapy induced nausea and vomiting during hematopoietic stem cell transplantation

This study aimed to evaluate the efficacy of antiemetic regimens in controlling chemotherapy-induced nausea and vomiting (CINV) among patients with haematological malignancies undergoing highly (HEC) or moderately emetogenic chemotherapy (MEC) as part of conditioning for hematopoietic stem cell transplantation (HSCT). A prospective cohort study was conducted from November 2022 to July 2024 at University Hospital Virgen del Rocío, Seville (Spain). Adult patients receiving HEC or MEC conditioning regimens were assessed for CINV control using a symptom questionnaire adapted from the validated questionnaire Pro-CTCAE. Effectiveness was measured by complete response (CR) and complete protection (CP) from nausea/emesis across acute (chemotherapy days) and delayed (five days post-chemotherapy) phases. Bitherapy (5HT3 receptor antagonists + corticosteroids) and monotherapy regimens were compared. 112 patients were included. Of 102 analysed patients, CR and CP were achieved in 42.1% and 34.3% of patients in the acute phase, and 33.3% and 30.4% in the delayed phase, respectively. Patients receiving bitherapy (who received myeloablative conditioning regimens and high-emetogenic regimens) achieved better CINV control compared to those treated with monotherapy (who received reduced-intensity and moderate emetogenic treatments). With significant improvements in acute CR (p = 0.0003) and CP (p = 0.001). Additionally, Rescue antiemetic use was lower in the bitherapy group (p = 0.230). This study reinforces the importance of assessment of antiemetic response in these patients and highlights the effectiveness of bitherapy with 5HT3 receptor antagonists and corticosteroids. However, our findings also suggest that antiemetic regimens could be optimised with strategies possibly involving triple therapy or the integration of other agents.