Antiemetic prophylaxis with fosaprepitant and granisetron in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation.

Abstract

BACKGROUND:

Chemotherapy-induced nausea and vomiting (CINV) is a severe and distressing complication during allogeneic hematopoietic stem cell transplantation (alloHSCT). The antiemetic fosaprepitant has shown favorable results in pediatric and adult patients receiving chemotherapy. Data on fosaprepitant in children and adolescents undergoing alloHSCT are missing.

METHODS:

In this non-interventional observation study, 120 children and adolescents with a median age of 11.8 years undergoing alloHSCT after a moderately or highly emetogenic conditioning (MEC or HEC) were analyzed. They received an antiemetic prophylaxis with granisetron (2 × 40 µg/kg d-1) with or without fosaprepitant (4 mg/kg; single dose, max. 1 × 150 mg/kg BW), and were analyzed in the control (CG; n = 60) or fosaprepitant group (FG; n = 60). The efficacy and safety of the two antiemetic prophylaxis regimens were analyzed and compared with respect to the acute (0-24 h) and the delayed (> 24-120 h) CINV phase and > 120-240 h after MEC or HEC administration.

RESULTS:

During MEC, significantly more patients in the CG experienced vomiting during the first 0-24 h (58.6 vs. 25.0%; p = 0.0156) and during > 24-120 h (93.1% vs. 57.1%; p = 0.0020), compared with the FG. Likewise, significantly more vomiting events (269 vs. 136; p < 0.0001) were registered in the CG. During HEC, significantly more patients in the CG experienced vomiting during the first 0-24 h (32.3 vs. 9.4%; p = 0.0319) compared with the FG. Significantly more vomiting events (241 vs. 99; p < 0.0001) were registered in the CG. Laboratory and clinical adverse events were not significantly different between the two groups (p > 0.05).

CONCLUSIONS:

Antiemetic prophylaxis with fosaprepitant and granisetron was well tolerated, safe, and effective in pediatric patients undergoing alloHSCT. However, larger prospective trials are necessary to evaluate these findings.

• Authors: Karin Melanie Cabanillas Stanchi, Julia Vek, Patrick Schlegel, Joachim Vincent Rupprecht, Tim Flaadt, Simone Weber, Sebastian Michaelis, Peter Lang, Rupert Handgretinger, Michaela Döring
• Journal: Journal of cancer research and clinical oncology (J Cancer Res Clin Oncol) Vol. 146 Issue 4 Pg. 1089-1100 (Apr 2020) ISSN: 1432-1335 [Electronic] Germany
• PMID: 32056007 (Publication Type: Journal Article, Observational Study)

Chemical References

• Antiemetics
• Morpholines
• fosaprepitant
• Granisetron

Topics

• Adolescent
• Antiemetics (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Child
• Child, Preschool
• Female
• Granisetron (administration & dosage)
• Hematologic Neoplasms (drug therapy, therapy)
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Infant
• Male
• Morpholines (administration & dosage)
• Nausea (chemically induced, prevention & control)
• Transplantation Conditioning (adverse effects, methods)
• Vomiting (chemically induced, prevention & control)