Abstract
Background: Chemotherapy-induced nausea and vomiting remain a significant problem during autologous stem cell transplantation, particularly during the delayed period of conditioning regimen chemotherapy. NEPA (netupitant+palonosetron) offers dual NK1/5-HT3 blockade in a single dose, but comparative evidence versus fosaprepitant+palonosetron in Autologous stem cell transplantation is limited.
Methods: We conducted a prospective, observational, non-randomized study at a tertiary cancer centre (September 2022–January 2025). Consecutive Transplant recipients received either BEAM (lymphoma) or melphalan (myeloma) conditioning. Antiemetic prophylaxis was NEPA (netupitant 300mg + palonosetron 0.5 mg) or fosaprepitant 150mg + palonosetron 0.25 mg. Vomiting episodes and CTCAE v4 grades were recorded daily. Acute (0–24 h), delayed (24–120 h), and overall (0–120 h) outcomes were analysed using Mann–Whitney and Chi-square tests.
Results: Sixty-five patients were included in the study (median age 42 years, with range 16–65; 60% male). Myeloma accounted for 34 (52.3%) and lymphoma 31 (47.7%). Antiemetic allocation was fosaprepitant+palonosetron in 43 (66.2%) and NEPA in 22 (33.8%), driven by affordability and availability.
Conditioning comparison: Acute outcomes were similar for BEAM versus melphalan (episodes 0.61 ± 1.54 versus 0.44 ± 0.93, p=0.828). In the delayed phase, BEAM showed a trend toward higher emesis (episodes 4.23 ± 4.30 versus 2.94 ± 4.57, p=0.105), with significantly higher vomiting grade on day 3 (p=0.042).
Antiemetic comparison: Acute, delayed, and overall summaries did not differ significantly between NEPA and fosaprepitant+palonosetron. On delayed day 5, NEPA was superior, with fewer episodes (0.32 ± 0.65 versus 0.88 ± 1.12; p=0.040) and lower vomiting grade (0.23 ± 0.43 versus 0.56 ± 0.67; p=0.047). No other day-wise differences were significant.
Conclusions: In this real-world Autologous stem cell transplantation cohort, NEPA and fosaprepitant+palonosetron achieved comparable overall control. NEPA conferred a distinct late delayed (day 5) benefit, while BEAM conditioning was associated with higher delayed vomiting grades than melphalan. NEPA may be preferred when late-phase control is critical. Larger randomized trials stratified by conditioning regimen are warranted.