Trifilio Steven, Welles Colleen, Seeger Kristin, Mehta Shivani, Fishman MaryAnne, McGowan Katherine, Strejcek Kathryn, Eiten Emily, Pirotte Carolyn, Lucier Elizabeth, DeFrates Sean, Mehta Jayesh
Northwestern Memorial Hospital, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL.
Northwestern Memorial Hospital, Chicago, IL.
Clin Lymphoma Myeloma Leuk. 2017 Sep;17(9):584-589. doi: 10.1016/j.clml.2017.06.012. Epub 2017 Jun 20.
Acute and delayed chemotherapy-induced nausea and vomiting (CINV) occurs in most patients who receive high-dose melphalan and significantly affects patients' quality of life during autologous stem cell transplantation. Faced with unsatisfactory results using an aprepitant-based regimen, an olanzapine-based regimen was initiated, with the hope of improving the incidence of acute and delayed CINV. A retrospective study was conducted to compare the effectiveness of olanzapine- versus aprepitant-based regimens for CINV prevention in adult hematopoietic stem cell recipients who received high-dose melphalan.
We compared olanzapine (n = 43) to aprepitant (n = 54) and fosaprepitant (n = 20). Olanzapine was given orally at 5 mg twice daily for 5 days, aprepitant was given at 125 mg on day -1 and 80 mg on days 0 and 1, and fosaprepitant was given at 150 mg on day -1. The dose of 2 concomitant drugs (dexamethasone and 5-hydroxytryptamine type 3 receptor antagonist) was similar in the 2 groups. Nausea prevention was the primary endpoint. A complete response using a composite index of no emesis and no use of rescue medications was the secondary endpoint.
The results showed that olanzapine significantly reduced the number of patients who experienced acute (P < .0001) or delayed (P < .004) nausea and significantly reduced the use of rescue medications for acute-onset (P < .0046) and delayed-onset (P < .0001) CINV compared with aprepitant.
Compared with fosaprepitant, olanzapine reduced the number of patients with acute (P < .0318) and delayed (P < .1519) nausea and reduced the need for rescue medications for acute-onset (P < .0643) and delayed-onset (P < .0024) CINV.
大多数接受大剂量美法仑治疗的患者会发生急性和延迟性化疗引起的恶心和呕吐（CINV），这会显著影响自体干细胞移植期间患者的生活质量。面对基于阿瑞匹坦的方案效果不尽人意的情况，启动了基于奥氮平的方案，以期改善急性和延迟性CINV的发生率。开展了一项回顾性研究，比较奥氮平方案与阿瑞匹坦方案对接受大剂量美法仑的成年造血干细胞接受者预防CINV的有效性。
我们将奥氮平组（n = 43）与阿瑞匹坦组（n = 54）和福沙匹坦组（n = 20）进行了比较。奥氮平口服，每日两次，每次5 mg，共5天；阿瑞匹坦在第-1天给予125 mg，在第0天和第1天给予80 mg；福沙匹坦在第-1天给予150 mg。两组中两种伴随药物（地塞米松和5-羟色胺3型受体拮抗剂）的剂量相似。预防恶心是主要终点。使用无呕吐且未使用救援药物的综合指标的完全缓解是次要终点。
结果显示，与阿瑞匹坦相比，奥氮平显著减少了发生急性（P <.0001）或延迟性（P <.004）恶心的患者数量，并显著减少了急性发作（P <.0046）和延迟发作（P <.0001）CINV的救援药物使用。
与福沙匹坦相比，奥氮平减少了急性（P <.0318）和延迟性（P <.1519）恶心的患者数量，并减少了急性发作（P <.0643）和延迟发作（P <.0024）CINV的救援药物需求。
