Multiple Myeloma Coverage from Every Angle

Antiemetic Option Under Study for Patients Receiving High-Dose Melphalan for Multiple Myeloma

By: Hope Craig, MSPH
Posted: Wednesday, October 6, 2021

Researchers in Italy conducted a prospective cohort study to assess the efficacy of the combination of netupitant plus palonosetron without dexamethasone in preventing chemotherapy-induced nausea and vomiting in patients with multiple myeloma who were receiving high-dose melphalan followed by autologous stem cell transplantation (ASCT). This oral combination therapy consists of a neurokinin 1 (NK1) receptor antagonist and a second-generation serotonin receptor antagonist. These findings from a single-center study, which showed the combination to be well tolerated and effective, were reported in Supportive Care in Cancer.

Led by Massimo Martino, MD, of the Morelli Hospital in Reggio Calabria, Italy, the study included 106 adults with multiple myeloma who were receiving high-dose melphalan and ASCT. Most patients were male (63%), and the median age was 60. All patients received antiemetic prophylaxis with multiple doses of the combination therapy 1 hour before the start of conditioning and after 72 hours and 120 hours. The primary outcome of interest was the complete response rate (no emesis and no rescue medication) at 120 hours after conditioning.

“We observed a safe and excellent control of chemotherapy-induced nausea and vomiting in this cohort of patients treated with a single oral administration with good compliance. Netupitant plus palonosetron administration resulted in a very high complete response rate during the acute (94.3%), delayed (95.2%), and overall (93.3%) phases,” the authors reported.

Furthermore, grade 1 nausea was reported by 82% of patients, and vomiting was experienced by 12%. Grade 2 nausea and vomited were reported by 18% and 10% of patients, respectively. Few patients experienced breakthrough emesis (2%), and one patient experienced more than two episodes of vomiting during the first 24 hours. About two-thirds of patients (n = 71) experienced weight loss at 7 days after ASCT, with a mean body weight loss of 2 kg (ranging from 0.5–8 kg).

Disclosure: Full authors’ disclosures are available at

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