LAUSR

Dear Editor, Chemotherapy-induced nausea and vomiting (CINV) can be associated with reduced quality of life and meaningful complications in multiple myeloma (MM) patients receiving high-dose (HD)-melphalan followed by autologous stem cell transplantation (ASCT) [1, 2]. Currently, a three-drug combination containing a neurokinin-1 receptor antagonist (NK1RA), a 5-hydroxytryptamine-3 (5-HT3)-RA, and corticosteroids is recommended as CINV prophylaxis regimen [3–5]. However, a survey recently published in this journal by the Gruppo Italiano Trapianto Midollo Osseo (GITMO) outlined that compliance of many transplant centers to CINV management recommendations is still suboptimal, despite the evidence suggesting that guideline conformity improves CINV control [6]. Netupitant-palonosetron (NEPA) is an oral, fixed combination of 300 mg of the NK1-RA netupitant and 0.5 mg of the 5HT3-RA palonosetron, which has been approved for highly and moderately emetogenic chemotherapy [7], but experience in the transplant setting is limited. Here, we report the results of a single institution, prospective, observational study, aiming to assess — to our knowledge for the first time — the efficacy and safety of NEPA (together with 10 mg oral dexamethasone) before HDmelphalan followed byASCT. Patients were given a questionnaire from day 1 to 5 to assess nausea and emesis. Nausea was graduated by patients on a visual analog scale (VAS). The primary endpoint was the absence of emesis and rescue medication requirement (complete response, CR) during the first 120 h after chemotherapy infusion. Significant nausea was defined as VAS > 25 mm. See also Supplementary Methods. We analyzed the outcome of 70 consecutive patients undergoing 80 ASCT procedures, with a median age of 59 years, Supplementary Table 1. CR rate during the 120-h observation period was 56% (45/80) and 68 cases (85%) had no episode of emesis; 43 patients (54%) did not report significant nausea. During the acute phase, CR rate was 83% (66/80), with 78 cases (98%) reporting no emesis and 66 (83%) no significant nausea, Fig. 1. The absence of nausea was obtained in 31 (39%) and 62 (78%) patients during the overall and acute phase, respectively, Supplementary Table 2. Male patients tended to have an improved 120-h CR rate (67% vs. 46%, p = 0.076) and showed a reduced incidence of significant nausea (33% vs. 59%, p = 0.027), Supplementary Table 3. No significant side effects likely related to NEPA were recorded, except one case of grade 2 headache and one of hiccup (grade 1). In our experience, NEPA was safe and effective in preventing CINV in MM patients receiving HD-melphalan and ASCT, with the advantage of a single-dose administration and without increasing costs compared to other 5HT3-RA plus NK1-RA combinations [8]. Thus, the use of NEPA could translate into better compliance, easier administration route and — hopefully — improved adherence to CINV management guidelines, conceivably in other transplant settings as Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04180-6) contains supplementary material, which is available to authorized users.