Efficacy And Safety Of Aprepitant In Preventing Nausea And Vomiting Caused By Pretreatment Chemotherapy Prior To Autologous Hematopoietic Stem Cell Transplantation:a Multicenter Retrospective Study

Objective:Through retrospective analysis the clinical data from multiple clinical research centers of aprepitant combined with tropisetron and dexamethasone in prevention the nausea and vomiting caused by chemotherapy(Chemotherapy induced nausea and vomiting,CINV)associated with pretreatment before autologous hematopoietic stem cell transplantation(auto-HSCT),to explore the clinical efficacy and adverse events of aprepitant to provide clinical reference for the prevention of CINV during hematopoietic stem cell transplantation.Method:Patients who underwent autologous hematopoietic stem cell transplantation at the Western Theater Air Force Hospital,PLA Joint Service 920 Hospital(Kunming General Hospital of PLA),Sichuan Provincial People's Hospital,and Western Theater General Hospital from August 2014 to August 2018 were selected through the electronic medical record system.Through exclusion and inclusion criteria,78 patients with malignant lymphoma,acute myeloid leukemia,and multiple myeloma who received pretreatment chemotherapy were finally included.46 patients in the aprepitant group and 32 in the non-aprepitant group.Through retrospective analysis,to explore the complete remission(Complete remission,CR)rate of aprepitant combined with tropisetron and dexamethasone in preventing the acute phase 1,2-7 days and overall CINV before auto-HSCT pretreatment,Salvage antiemetic and intravenous nutrition support,hematopoietic reconstruction,PFS and its adverse reactions.Result:1.CINV complete response rate:Compared with the non-Aprepitant group,pretreatment chemotherapy on the first day of the aprepitant group significantly increased the CR rate from 53.1%to 82.6%(P=0.005);the overall CR rate also increased significantly from 15.6%to 56.5%(P<0.001);CR rates at 2 to 7 days also increased significantly(P<0.05),respectively.2.Salvage antiemetics:On the first to seventh days of pretreatment chemotherapy,the aprepitant group significantly reduced the use of rescue antiemetics compared with the non-aprepitant group;the overall use of rescue antiemetics was also significantly reduced,which were 37.0%vs 81.3%(P<0.01);and aprepitant reduces the duration of rescue antiemetic medications(P=0.01).3.Intravenous nutrition support:The overall utilization rate of intravenous nutrition support in both groups was 100%,but aprepitant could significantly extend the first time to receive intravenous nutrition support from 6.9 days to 9.0 days(P=0.008).4.Hematopoietic function recovery:The neutrophil and platelet implantation time of the two groups of patients was 11.6 days vs 11.8 days and 13.2 days vs 13.6 days,respectively,and there was no significant difference.5.PFS:There was no difference in 2 years PFS between the two groups of patients,which were 74.0%vs 75.0%.6.Adverse events:The adverse events in the two groups were mainly diarrhea,headache,anorexia,insomnia,abdominal pain,constipation,dizziness,etc.,but the incidence was similar,and both were grade 2 or lower.Conclusion:Aprepitant combined with tropisetron and dexamethasone can significantly improve the CR rate of CINV caused by pretreatment chemotherapy before autologous hematopoietic stem cell transplantation and can reduce the rate of rescue antiemetic drugs,shorten the use of rescue antiemetic drugs and prolong the first time Intravenous nutritional support time without affecting hematopoietic function recovery and PFS,and the adverse events are tolerable.