First-generation
5-hydroxytryptamine type 3 (5-HT3) receptor antagonists (RAs) are currently the standard of care for prophylaxis against allo-HSCT-induced
emesis. However, the efficacy of this combination in allo-HSCT recipients is not entirely satisfying. We sought to compare the efficacy of first-generation 5-HT3 RAs with that of second-generation 5-HT3 RAs in
emesis prevention in allo-HSCT recipients. A total of 51 consecutive patients undergoing allo-HSCT for various
hematological diseases in our institution were retrospectively reviewed. Patients who received daily first-generation 5-HT3 RAs, and 60-h
palonosetron for
emesis prophylaxis were stratified into the standard (n = 23) and
palonosetron (n = 28) groups, respectively.
Emesis severity and rescue
therapy requirements in patients between these two groups were compared. Our results showed patients in standard and
palonosetron groups had comparable severity of both acute and delayed
emesis. However, 52.2 % of the patients in the standard group required rescue
therapy, compared to only 21.4 % of the patients in the
palonosetron group (p = 0.046). Subgroup analysis showed rescue
therapy for acute
emesis was required by 26.1 % of the patients in the standard group and by only 3.6 % of the patients in the
palonosetron group (p = 0.037). In conclusion,
palonosetron and first-generation 5-HT3 RAs were at least equally effective in
emesis prophylaxis for allo-HSCT recipients. Patients receiving
palonosetron, especially for acute
emesis, required rescue
therapy less frequently than those receiving first-generation 5-HT3 RAs.