Prevention of CINV in Patients Receiving High-Dose Multiple-Day Chemotherapy

  • Luigi CelioEmail author


High-dose chemotherapy involves the administration of potentially toxic doses of chemotherapeutic agents in an effort to eradicate cancer cells. A wide range of high-dose regimens has been developed and they typically consist of several agents given at high doses over 2–7 days. The use of peripheral blood as a source of stem cells for autologous hematopoietic stem-cell transplantation (HSCT) greatly contributed to the application of myeloablative chemotherapy in the treatment of both hematological and solid malignancies. In the setting of HSCT, chemotherapy-induced nausea and vomiting (CINV) are almost universal and may occur not only during administration of anticancer agents but also for days or weeks during the recovery period from chemotherapy. In addition, irradiation used in many preparative regimens is associated with a number of acute side effects that include nausea and vomiting, compounding the side effects of chemotherapy. Therefore, high-dose multiple-day chemotherapy with HSCT provides a unique challenge to achieving good antiemetic control and remains one of the neglected areas of antiemetic research. There are difficulties in developing evidenced-based recommendations for the optimal strategy of CINV control in this setting. The chapter provides an overview of CINV in patients undergoing high-dose chemotherapy regimens, with a focus on challenges and unmet needs in this special population. It also provides an overview of the results with modern antiemetics in this setting. Finally, current treatment guidelines are also discussed along with suggestions for future investigations.


CINV High-dose chemotherapy NK-1 receptor antagonist Palonosetron Aprepitant Stem-cell transplantation 


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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Medical Oncology 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly

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