Contributions
Abstract: PB2433
Type: Publication Only
Background
High dose Melphalan is standard conditioning chemotherapy for patients with Myeloma and Lymphoma for autologous stem cell transplant (ASCT). This is a highly emetic regimen and despite the use of the 5-HT3 receptor antagonists, nausea and vomiting continues to be a problem. During 2016 we noticed a high use of subcutaneous infusion of levopromethazine in this patient group. This anti-emetic can result in patient drowsiness, potential injection site infection and demands on nursing time. We performed a pilot study using the new antiemetic Akynzeo (netupitant and palonosetron hydrochloride 300mg/0.5mg) given prior to high dose Melphalan.
Aims
The study aimed to reduce the incidence of nausea and vomiting associated with high dose melphalan chemotherapy using a novel antiemetic regimen. We hope to demonstrate a resultant improvement in nutritional intake and a reduction in length of hospital admission.
Methods
From 29/12/15 to 4/1/17, 24 consecutive patients were treated with high dose Melphalan as part of an ASCT protocol (22 Myeloma patients and 2 lymphoma patients). The first 12 patients were treated using our standard anti-emetic protocol of regular Ondansetron 8mg bd and metaclopromide 10mg tds from D1 chemotherapy. In addition as required doses and continuous sc infusions of Levopromethazine were used as needed. The subsequent 12 patients were given a novel anti-emetic protocol of Akynzeo single dose on D1 chemo with dexamethasone 12mg orally D1 and 8mg orally D2-4 as per Akynzeo product specification. No other regular anti-emetics were used during the ASCT admission period. As required doses of metaclopromide and as required doses and continuous sc infusions of Levopromethazine were utilised. Retrospective analysis was made of all 24 patients. Factors analysed were: number of days of nausea and vomiting documented in medical notes with CTCAE grade. Number of days of reduced nutritional intake, all antiemetic drugs used, use of subcutaneous infusion Levopromethazine, duration of inpatient admission. Results from the 2 cohorts of patients were compared. Anti-emetic drug costs and nursing time required were also considered.
Results
There was a significant reduction seen in days of recorded nausea, vomiting, poor nutritional intake, subcutaneous levopromethazine pump usage and overall length of hospital stay in the pilot study group receiving the novel anti-emetic Akynzeo (see table).
| Average number days | nausea overall | nausea grade 1 | nausea grade 2 | vomiting grade1 | reduced nutritional intake | sc levo pump use | sc pump inflammation | ondansetron use | metaclopromide use | length hospital admission |
| standard antiemetic regimen | 4.9 | 2.85 | 2.9 | 2.6 | 8.5 | 8.33 | 0.83 | 17.21 | 14.13 | 19.83 |
| Akynzeo antiemetic regimen | 0.79 | 1.5 | 0.08 | 0.08 | 1.84 | 0 | 0 | 0.83 | 12.69 | 17.67 |
Conclusion
The anti-emetic regimen of single dose Akynzeo with dexamethasone resulted in a reduction in nausea and vomiting. Cessation of subcutaneous levopromethazine infusion usage and a reduction in length of hospital admission was seen in the Akynzeo group. The Akynzeo anti-emetic regimen drug cost was higher (average £78 vs £24 in the standard regimen group) but the saving in length of hospital stay, nursing time and positive patient experience is significant. We now use the Akynzeo regimen as our anti-emetic protocol for all ASCT conditioning regimens.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, lymphoma, Melphalan, Myeloma
Abstract: PB2433
Type: Publication Only
Background
High dose Melphalan is standard conditioning chemotherapy for patients with Myeloma and Lymphoma for autologous stem cell transplant (ASCT). This is a highly emetic regimen and despite the use of the 5-HT3 receptor antagonists, nausea and vomiting continues to be a problem. During 2016 we noticed a high use of subcutaneous infusion of levopromethazine in this patient group. This anti-emetic can result in patient drowsiness, potential injection site infection and demands on nursing time. We performed a pilot study using the new antiemetic Akynzeo (netupitant and palonosetron hydrochloride 300mg/0.5mg) given prior to high dose Melphalan.
Aims
The study aimed to reduce the incidence of nausea and vomiting associated with high dose melphalan chemotherapy using a novel antiemetic regimen. We hope to demonstrate a resultant improvement in nutritional intake and a reduction in length of hospital admission.
Methods
From 29/12/15 to 4/1/17, 24 consecutive patients were treated with high dose Melphalan as part of an ASCT protocol (22 Myeloma patients and 2 lymphoma patients). The first 12 patients were treated using our standard anti-emetic protocol of regular Ondansetron 8mg bd and metaclopromide 10mg tds from D1 chemotherapy. In addition as required doses and continuous sc infusions of Levopromethazine were used as needed. The subsequent 12 patients were given a novel anti-emetic protocol of Akynzeo single dose on D1 chemo with dexamethasone 12mg orally D1 and 8mg orally D2-4 as per Akynzeo product specification. No other regular anti-emetics were used during the ASCT admission period. As required doses of metaclopromide and as required doses and continuous sc infusions of Levopromethazine were utilised. Retrospective analysis was made of all 24 patients. Factors analysed were: number of days of nausea and vomiting documented in medical notes with CTCAE grade. Number of days of reduced nutritional intake, all antiemetic drugs used, use of subcutaneous infusion Levopromethazine, duration of inpatient admission. Results from the 2 cohorts of patients were compared. Anti-emetic drug costs and nursing time required were also considered.
Results
There was a significant reduction seen in days of recorded nausea, vomiting, poor nutritional intake, subcutaneous levopromethazine pump usage and overall length of hospital stay in the pilot study group receiving the novel anti-emetic Akynzeo (see table).
| Average number days | nausea overall | nausea grade 1 | nausea grade 2 | vomiting grade1 | reduced nutritional intake | sc levo pump use | sc pump inflammation | ondansetron use | metaclopromide use | length hospital admission |
| standard antiemetic regimen | 4.9 | 2.85 | 2.9 | 2.6 | 8.5 | 8.33 | 0.83 | 17.21 | 14.13 | 19.83 |
| Akynzeo antiemetic regimen | 0.79 | 1.5 | 0.08 | 0.08 | 1.84 | 0 | 0 | 0.83 | 12.69 | 17.67 |
Conclusion
The anti-emetic regimen of single dose Akynzeo with dexamethasone resulted in a reduction in nausea and vomiting. Cessation of subcutaneous levopromethazine infusion usage and a reduction in length of hospital admission was seen in the Akynzeo group. The Akynzeo anti-emetic regimen drug cost was higher (average £78 vs £24 in the standard regimen group) but the saving in length of hospital stay, nursing time and positive patient experience is significant. We now use the Akynzeo regimen as our anti-emetic protocol for all ASCT conditioning regimens.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, lymphoma, Melphalan, Myeloma