Skip to main content


Log in

Transplant Toxicities

The burden of chemotherapy-induced nausea and vomiting in children receiving hematopoietic stem cell transplantation conditioning: a prospective study

  • Original Article
  • Published:
Bone Marrow Transplantation Submit manuscript


This prospective study describes chemotherapy-induced nausea and vomiting (CINV) in children (4–18 years) receiving their first hematopoietic stem cell transplant. Emetic episodes, nausea severity (assessed using a validated, self-report nausea severity assessment tool) and antiemetic administration were documented from the start of conditioning until 24 h after the last conditioning agent was administered (acute) and for a further 7 days (delayed). Relationships between CINV control and parenteral nutrition (PN) use and acute gut GvHD (aGvHD) were explored. Fifty-nine children (4.6–17.4 years) were evaluable. Complete chemotherapy-induced vomiting (CIV; acute: 24%; delayed 22%) and chemotherapy-induced nausea (CIN; acute 7%; delayed 12%) control rates were low. Few children experienced complete CINV control (no vomiting/retching and no nausea) during the acute (5%) or delayed phases (12%). Children experiencing complete acute or delayed CIN control or complete delayed CIV control were more likely to have received: a lower proportion of their total energy requirement as PN at the end of the delayed phase (P<0.036) and PN for a shorter time (P<0.044). Low patient numbers did not permit evaluation of the association between gut aGvHD and CINV control. Effective and safe interventions aimed at improving CINV control in children are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others


  1. Basch E, Prestrud A, Hesketh P, Kris M, Feyer P, Somerfield MR et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2011; 29: 4189–4198.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Molassiotis A, Stamataki Z, Kontopantelis E . Development and preliminary validation of a risk prediction model for chemotherapy-related nausea and vomiting. Support Care Cancer 2013; 21: 2759–2767.

    Article  CAS  PubMed  Google Scholar 

  3. Papadopoulou A, MacDonald A, Williams M, Darbyshire P, Booth I . Enteral nutrition after bone marrow transplantation. Arch Dis Child 1997; 77: 131–136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mattsson J, Westin S, Edlund S, Remberger M . Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease. Bone Marrow Transplant 2006; 38: 629–633.

    Article  CAS  PubMed  Google Scholar 

  5. Thorvaldson L, Remberger M, Winiarski J, Omazic B, Fischler B, Sundin M . HLA, GVHD, and parenteral nutrition are risk factors for hepatic complications in pediatric HSCT. Pediatr Transplant 2016; 20: 96–104.

    Article  PubMed  Google Scholar 

  6. Kuiken N, Rings E, Havinga R, Groen A, Tissing W . Effect of minimal enteral feeding on recovery in a methotrexate-induced gastrointestinal mucositis rat model. Support Care Cancer 2016; 24: 1357–1364.

    Article  PubMed  Google Scholar 

  7. Kusnierczyk N, Saunders EF, Dupuis LL . Outcomes of antiemetic prophylaxis in children undergoing bone marrow transplantation. Bone Marrow Transplant 2002; 30: 119–124.

    Article  CAS  PubMed  Google Scholar 

  8. Dupuis LL, Taddio A, Kerr EN, Kelly A, MacKeigan L . Development and validation of a pediatric nausea assessment tool (PeNAT) for use by children receiving antineoplastic agents. Pharmacotherapy 2006; 26: 1221–1231.

    Article  PubMed  Google Scholar 

  9. Dupuis LL, Boodhan S, Sung L, Portwine C, Hain R, McCarthy P et al. Guideline for the classification of the acute emetogenic potential of antineoplastic medication in pediatric cancer patients. Pediatr Blood Cancer 2011; 57: 191–198.

    Article  PubMed  Google Scholar 

  10. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  11. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 Consensus Conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  12. Orchard P, Rogosheske J, Burns L, Rydholm N, Larson H, DeFor T et al. A prospective randomized trial of the anti-emetic efficacy of ondansetron and granisetron during bone marrow transplantation. Biol Blood Marrow Transplant 1999; 5: 386–393.

    Article  CAS  PubMed  Google Scholar 

  13. Hewitt M, Cornish J, Pamphilon D, Oakhill A . Effective emetic control during conditioning of children for bone marrow transplantation using ondansetron, a 5-HT3 antagonist. Bone Marrow Transplant 1991; 7: 431–433.

    CAS  PubMed  Google Scholar 

  14. Frakes L, Brehm T, Kosty M, Miller W, mcMillan R, Mason J et al. An all oral antiemetic regimen for patients undergoing high-dose chemotherapy with peripheral blood stem cell transplant. Bone Marrow Transplant 1997; 20: 473–478.

    Article  CAS  PubMed  Google Scholar 

  15. Andrews P, Sanger G . Nausea and the quest for the perfect anti-emetic. Eur J Pharmacol 2014; 722: 108–121.

    Article  CAS  PubMed  Google Scholar 

  16. Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting. N Engl J Med 2016; 375: 134–142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Cruz F, de Iracema Gomes Cubero D, Taranto P, Lerner T, Thaunaturgo Lera A, da Costa Miranda M et al. Gabapentin for the prevention of chemotherapy- induced nausea and vomiting: a pilot study. Support Care Cancer 2012; 20: 601–606.

    Article  PubMed  Google Scholar 

  18. Rodgers C, Young A, Hockenberry M, Binder B, Symes L . The meaning of adolescents' eating experiences during bone marrow transplant recovery. J Pediatr Oncol Nurs 2010; 27: 65–72.

    Article  PubMed  Google Scholar 

Download references


The generosity of the children and families who participated in this study is sincerely appreciated. The support and contributions of the nursing, medical and pharmacy staff of the Bone Marrow Transplantation Unit at The Hospital for Sick Children, and the assistance of Ms Mila Khanna and Ms Ashlee Vennettilli, Clinical Research Project Coordinators, Research Institute, The Hospital for Sick Children are gratefully acknowledged.

Author information

Authors and Affiliations


Corresponding author

Correspondence to L L Dupuis.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Flank, J., Sparavalo, J., Vol, H. et al. The burden of chemotherapy-induced nausea and vomiting in children receiving hematopoietic stem cell transplantation conditioning: a prospective study. Bone Marrow Transplant 52, 1294–1299 (2017).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

  • Springer Nature Limited

This article is cited by