Yeh Su-Peng, Lo Woei-Chung, Hsieh Ching-Yun, Bai Li-Yuan, Lin Ching-Chan, Lin Po-Han, Lin Chen-Yuan, Liao Yu-Min, Chiu Chang-Fang
Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, 2 Yuh Der Road, Taichung 404, Taiwan,
Support Care Cancer. 2014 May;22(5):1199-206. doi: 10.1007/s00520-013-2072-4. Epub 2013 Dec 7.
The primary aim of this study was to evaluate the efficacy of palonosetron combined with dexamethasone in the prevention of vomiting, and especially nausea, in patients receiving allogeneic stem cell transplantation.
Palonosetron 0.25 mg was given to 27 patients receiving allogeneic transplantation on the first day of conditioning, and then every other day during the entire conditioning period. Dexamethasone was given daily also during conditioning. Vomiting and nausea were recorded daily according to CTCAE version 4.0 from the start of conditioning to Day 7 after transplantation. In addition, MASCC antiemetic tool (MAT) was also used in parallel to evaluate the intensity of nausea.
The treatment was well tolerated; 25.9 and 40.7 % of the patients had grade 2/3 vomiting and nausea respectively during conditioning. The incidences of grade 2/3 vomiting and nausea were even higher in the first week after transplantation (40.7 and 51.8 %, respectively). The score of MAT correlated well with the grade of CTCAE. However, the difference in the mean intensity of nausea between period of conditioning and the first week after HSCT was significant only by using MAT (0.96 ± 1.829 vs. 3.81 ± 3.386, p=0.001) but not CTCAE (1.26 ± 0.903 vs. 1.63 ±0.967, p=0.152).
Palonosetron combined with dexamethasone is effective in preventing vomiting during conditioning. However, more effort should be made to alleviate nausea during conditioning and both nausea and vomiting in the first week after transplantation. Furthermore, MAT has a higher discriminant power than CTCAE in assessing the intensity of nausea in patients receiving allogeneic transplantation.
本研究的主要目的是评估帕洛诺司琼联合地塞米松预防接受异基因干细胞移植患者呕吐尤其是恶心的疗效。
27例接受异基因移植的患者在预处理第一天给予0.25mg帕洛诺司琼，然后在整个预处理期间每隔一天给药一次。预处理期间也每天给予地塞米松。从预处理开始至移植后第7天，根据CTCAE 4.0版每日记录呕吐和恶心情况。此外，还同时使用MASCC止吐工具（MAT）评估恶心强度。
该治疗耐受性良好；25.9%和40.7%的患者在预处理期间分别出现2/3级呕吐和恶心。移植后第一周2/3级呕吐和恶心的发生率甚至更高（分别为40.7%和51.8%）。MAT评分与CTCAE分级相关性良好。然而，仅使用MAT时，预处理期与造血干细胞移植后第一周恶心的平均强度差异有统计学意义（0.96±1.829对3.81±3.386，p=0.001），而CTCAE无差异（1.26±0.903对1.63±0.967，p=0.152）。
帕洛诺司琼联合地塞米松在预处理期间预防呕吐有效。然而，应更加努力减轻预处理期间的恶心以及移植后第一周的恶心和呕吐。此外，在评估接受异基因移植患者的恶心强度方面，MAT比CTCAE具有更高的判别能力。
