Use of ondansetron in the control of emesis in autologous peripheral blood stem cell transplant (APBSCT) for solid tumours

The use of autologous peripheral blood stem cell transplant (APBSCT) for solid tumours have increased exponentially in the last 5 years. While the use of 5-hydroxytryptamine 3 (5HT3) receptor antagonists has been shown to improve control of emesis in patients receiving conventional dose chemotherapy, similar literature in APBSCT is more limited. We report our experience in the use of ondansetron in APBSCT. Twenty-three patients with solid tumours receiving high-dose chemotherapy with APBSCT were studied. All were started on intravenous ondansetron at 24 mg/day before commencement of the conditioning regimen and continued till vomiting had ceased for 24 hours. The conditioning regimen used was dependent on the tumour type and the duration ranged from 4 to 6 days. Control of emesis was assessed by the number of vomiting episodes in each 24-hour period, monitored throughout conditioning till discharge from hospital. Complete or major protection from vomiting was achieved in 83% of patients on day 1. During the entire conditioning period, 52% of patients achieved complete or major response to ondansetron. After the conditioning period (delayed emesis), 44% of patients achieved complete or major response. The control of emesis for patients undergoing high-dose chemotherapy with APBSCT is fair with ondansetron. Research on more effective combinations to further improve emetic control in this selected group of patients is needed.