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Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation

BACKGROUND: High-dose myeloablative conditioning prior to autologous hematopoietic stem cell transplantation (autoHSCT) in pediatric patients is usually highly emetogenic. The antiemetic neurokinin-1 receptor antagonist fosaprepitant was safe and effective in children receiving highly emetogenic che...

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Autores principales: Cabanillas Stanchi, Karin Melanie, Willier, Semjon, Vek, Julia, Schlegel, Patrick, Queudeville, Manon, Rieflin, Nora, Klaus, Veronika, Gansel, Melanie, Rupprecht, Joachim Vincent, Flaadt, Tim, Binder, Vera, Feuchtinger, Tobias, Lang, Peter, Handgretinger, Rupert, Döring, Michaela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524181/
https://www.ncbi.nlm.nih.gov/pubmed/33061297
http://dx.doi.org/10.2147/DDDT.S260887
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author Cabanillas Stanchi, Karin Melanie
Willier, Semjon
Vek, Julia
Schlegel, Patrick
Queudeville, Manon
Rieflin, Nora
Klaus, Veronika
Gansel, Melanie
Rupprecht, Joachim Vincent
Flaadt, Tim
Binder, Vera
Feuchtinger, Tobias
Lang, Peter
Handgretinger, Rupert
Döring, Michaela
author_facet Cabanillas Stanchi, Karin Melanie
Willier, Semjon
Vek, Julia
Schlegel, Patrick
Queudeville, Manon
Rieflin, Nora
Klaus, Veronika
Gansel, Melanie
Rupprecht, Joachim Vincent
Flaadt, Tim
Binder, Vera
Feuchtinger, Tobias
Lang, Peter
Handgretinger, Rupert
Döring, Michaela
author_sort Cabanillas Stanchi, Karin Melanie
collection PubMed
description BACKGROUND: High-dose myeloablative conditioning prior to autologous hematopoietic stem cell transplantation (autoHSCT) in pediatric patients is usually highly emetogenic. The antiemetic neurokinin-1 receptor antagonist fosaprepitant was safe and effective in children receiving highly emetogenic chemotherapy. Data on fosaprepitant during autoHSCT in children are currently not available. METHODS: A total of 35 consecutive pediatric patients, who received an antiemetic prophylaxis with fosaprepitant (4 mg/kg; single dose, max. 1 x 150 mg/kg BW) and ondansetron (24-hours continuous infusion; 8–32 mg/24h) or granisetron (2 x 40 µg/kg∙d(−1)) during highly emetogenic conditioning chemotherapy before autoHSCT were retrospectively analyzed, and their results were compared with a control group comprising 35 consecutive pediatric patients, who received granisetron or ondansetron only. The antiemetic efficacy and the safety of the two prophylaxis regimens were compared with respect to three time periods after the first chemotherapy administration (0–24h, >24–120h, >120–240h). RESULTS: Clinical adverse events and clinically relevant increases/decreases of laboratory markers were similarly low and did not significantly differ between the two study groups (p>0.05). The registered number of vomiting events was significantly higher in the control group in the time periods of 0–24h (64 vs 22 events; p<0.01), >24–120h (135 vs 78 events; p<0.0001), >120–240h (268 vs 105 events; p<0.0001), and the whole observation period 0–240h (467 vs 205 events; p<0.0001). The percentage of patients experiencing vomiting was higher in the control group during the time period of >24–120h (100% vs 74.3%) but not the other analyzed time periods (p>0.05). CONCLUSION: The fosaprepitant-based antiemetic prophylaxis was safe, well tolerated and significantly reduced vomiting in children undergoing highly emetogenic chemotherapy prior to autoHSCT. Prospective randomized trials are necessary to confirm these results.
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spelling pubmed-75241812020-10-14 Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation Cabanillas Stanchi, Karin Melanie Willier, Semjon Vek, Julia Schlegel, Patrick Queudeville, Manon Rieflin, Nora Klaus, Veronika Gansel, Melanie Rupprecht, Joachim Vincent Flaadt, Tim Binder, Vera Feuchtinger, Tobias Lang, Peter Handgretinger, Rupert Döring, Michaela Drug Des Devel Ther Original Research BACKGROUND: High-dose myeloablative conditioning prior to autologous hematopoietic stem cell transplantation (autoHSCT) in pediatric patients is usually highly emetogenic. The antiemetic neurokinin-1 receptor antagonist fosaprepitant was safe and effective in children receiving highly emetogenic chemotherapy. Data on fosaprepitant during autoHSCT in children are currently not available. METHODS: A total of 35 consecutive pediatric patients, who received an antiemetic prophylaxis with fosaprepitant (4 mg/kg; single dose, max. 1 x 150 mg/kg BW) and ondansetron (24-hours continuous infusion; 8–32 mg/24h) or granisetron (2 x 40 µg/kg∙d(−1)) during highly emetogenic conditioning chemotherapy before autoHSCT were retrospectively analyzed, and their results were compared with a control group comprising 35 consecutive pediatric patients, who received granisetron or ondansetron only. The antiemetic efficacy and the safety of the two prophylaxis regimens were compared with respect to three time periods after the first chemotherapy administration (0–24h, >24–120h, >120–240h). RESULTS: Clinical adverse events and clinically relevant increases/decreases of laboratory markers were similarly low and did not significantly differ between the two study groups (p>0.05). The registered number of vomiting events was significantly higher in the control group in the time periods of 0–24h (64 vs 22 events; p<0.01), >24–120h (135 vs 78 events; p<0.0001), >120–240h (268 vs 105 events; p<0.0001), and the whole observation period 0–240h (467 vs 205 events; p<0.0001). The percentage of patients experiencing vomiting was higher in the control group during the time period of >24–120h (100% vs 74.3%) but not the other analyzed time periods (p>0.05). CONCLUSION: The fosaprepitant-based antiemetic prophylaxis was safe, well tolerated and significantly reduced vomiting in children undergoing highly emetogenic chemotherapy prior to autoHSCT. Prospective randomized trials are necessary to confirm these results. Dove 2020-09-25 /pmc/articles/PMC7524181/ /pubmed/33061297 http://dx.doi.org/10.2147/DDDT.S260887 Text en © 2020 Cabanillas Stanchi et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Cabanillas Stanchi, Karin Melanie
Willier, Semjon
Vek, Julia
Schlegel, Patrick
Queudeville, Manon
Rieflin, Nora
Klaus, Veronika
Gansel, Melanie
Rupprecht, Joachim Vincent
Flaadt, Tim
Binder, Vera
Feuchtinger, Tobias
Lang, Peter
Handgretinger, Rupert
Döring, Michaela
Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation
title Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation
title_full Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation
title_fullStr Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation
title_full_unstemmed Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation
title_short Antiemetic Prophylaxis with Fosaprepitant and 5-HT(3)-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation
title_sort antiemetic prophylaxis with fosaprepitant and 5-ht(3)-receptor antagonists in pediatric patients undergoing autologous hematopoietic stem cell transplantation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524181/
https://www.ncbi.nlm.nih.gov/pubmed/33061297
http://dx.doi.org/10.2147/DDDT.S260887
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