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. 2025 Aug 11;33(9):777.
doi: 10.1007/s00520-025-09839-2.

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

Junpei Kato  1   2 , Masashi Uchida  3 , Masayuki Ishikawa  2   4 , Shinya Tatsuta  1 , Takeshi Yoshimi  1 , Kota Ishida  1 , Osamu Hosoya  1 , Nobuhiro Tsukada  5 , Tadao Ishida  5 , Yuki Shiko  6 , Yohei Kawasaki  6 , Shingo Yamazaki  2   4 , Itsuko Ishii  2   4
Affiliations

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

Junpei Kato et al. Support Care Cancer. .

Abstract

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.

Keywords: Autologous stem cell transplantation multiple myeloma; Chemotherapy-induced nausea and vomiting; High-dose melphalan; Olanzapine.

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Conflict of interest statement

Declarations. Ethics approval: This study was conducted in compliance with the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects (guidelines issued by the Japanese Government). This study approved by the ethics committees of the Japanese Red Cross Medical Center (reference number: 1443). Consent to participate: Information on this study was available on the webpage of the Japanese Red Cross Medical Center. Patients were notified about their participation in the study and informed that they were free to opt out. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CR rate during each phase. Statistical analysis was performed using Fisher’s exact test. * p < 0.05, *** p < 0.001. CR, complete response; IAR, intensive antiemetic regimen
Fig. 2
Fig. 2
Incidence of grade 3 nausea during each phase. The incidence of grade 3 nausea was assessed based on the use of total parenteral nutrition in each phase. Statistical analysis was performed using Fisher’s exact test. *** p < 0.001. IAR, intensive antiemetic regimen
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