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Purpose <p>Conditioning with high-dose melphalan (MEL) followed by autologous stem cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM). The optimal regimen to prevent chemotherapy-induced nausea and vomiting (CINV) is unclear. We aimed to retrospectively evaluate the antiemetic effect and safety of a four-drug intensive regimen including olanzapine (OLA) on CINV in MM patients receiving MEL/ASCT.</p> Methods <p>MEL (200&#xa0;mg/m<sup>2</sup>) was administered on day 1, followed by ASCT on day 3. Patients were classified into the standard group (palonosetron and dexamethasone on day 1, and aprepitant on day 1–3), and the intensive antiemetic regimen (IAR) group (palonosetron on day 1, dexamethasone on day 1–2, and aprepitant, and OLA on day 1–5). The primary endpoint was defined as no vomiting and no rescue medications (complete response) in the delayed phase (day 2–5).</p> Results <p>There were no significant differences in baseline characteristics between the OLA (n = 68) and standard (n = 54) groups. The complete response rate in the IAR group was significantly higher in the delayed phase (52.9% vs. 31.4%, <i>p</i> &lt; 0.05). Multivariate analysis revealed that the IAR was associated with the complete response rate (OR, 2.34; 95% CI, 1.09–5.00; <i>p</i> = 0.028). The incidence of nausea (grade 3) in the delayed phase was lower in the IAR group (44.1% vs. 75.9%, <i>p</i> &lt; 0.001).</p> Conclusion <p>The four-drug intensive regimen including OLA may improve the antiemetic effect on delayed CINV while also ensuring safety in MM patients undergoing MEL/ASCT.</p>

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Efficacy of intensive antiemetic therapy including olanzapine in multiple myeloma patients treated with high-dose melphalan with autologous stem cell transplantation

  • 期刊论文

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  • 发表日期：

    2025年8月11日

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  • Junpei Kato,
  • Masashi Uchida,
  • Masayuki Ishikawa,
  • Shinya Tatsuta,
  • Takeshi Yoshimi,
  • Kota Ishida,
  • Osamu Hosoya,
  • Nobuhiro Tsukada,
  • Tadao Ishida,
  • Yuki Shiko,
  • Yohei Kawasaki,
  • Shingo Yamazaki,
  • Itsuko Ishii

摘要

Purpose

Conditioning with high-dose melphalan (MEL) followed by autologous stem cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM). The optimal regimen to prevent chemotherapy-induced nausea and vomiting (CINV) is unclear. We aimed to retrospectively evaluate the antiemetic effect and safety of a four-drug intensive regimen including olanzapine (OLA) on CINV in MM patients receiving MEL/ASCT.

Methods

MEL (200 mg/m2) was administered on day 1, followed by ASCT on day 3. Patients were classified into the standard group (palonosetron and dexamethasone on day 1, and aprepitant on day 1–3), and the intensive antiemetic regimen (IAR) group (palonosetron on day 1, dexamethasone on day 1–2, and aprepitant, and OLA on day 1–5). The primary endpoint was defined as no vomiting and no rescue medications (complete response) in the delayed phase (day 2–5).

Results

There were no significant differences in baseline characteristics between the OLA (n = 68) and standard (n = 54) groups. The complete response rate in the IAR group was significantly higher in the delayed phase (52.9% vs. 31.4%, p < 0.05). Multivariate analysis revealed that the IAR was associated with the complete response rate (OR, 2.34; 95% CI, 1.09–5.00; p = 0.028). The incidence of nausea (grade 3) in the delayed phase was lower in the IAR group (44.1% vs. 75.9%, p < 0.001).

Conclusion

The four-drug intensive regimen including OLA may improve the antiemetic effect on delayed CINV while also ensuring safety in MM patients undergoing MEL/ASCT.