PROLONGED NAUSEA AND VOMITING AFTER HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS PERIPHERAL STEM-CELL TRANSPLANTATION IN THE TREATMENT OF HIGH-RISK BREAST-CARCINOMA

BACKGROUND. Nausea and vomiting immediately after chemotherapy is a we ll recognized complication of cancer drug treatment; it is usually sho re-lived and controllable by modem antiemetics. The authors report a h igh incidence of prolonged nausea and vomiting after high dose chemoth erapy with autologous peripheral stem cell transplantation (PSCT) in t he treatment of high risk breast carcinoma patients. METHODS, Patients with high risk breast carcinoma were conditioned with high dose carmu stine, cisplatin, and cyclophosphamide followed by autologous PSCT. In Part I of the study, patients who received PSCT at UCLA Medical Cente r were identified if they were either readmitted with dehydration seco ndary to nausea and vomiting or referred to a gastroenterology special ist for the treatment of intractable nausea and vomiting. In Part II o f the study, the authors examined a series of 38 women treated at UCLA Medical Center in 1993 for high risk breast carcinoma to determine th e incidence of prolonged postchemotherapy nausea and vomiting (PPNV) a fter PSCT. These women were followed at 2-week intervals with a qualit y of life evaluation that included questions about nausea and vomiting . RESULTS, In Part I of the study, the authors identified 9 women with more than 1 month of significant nausea and vomiting after PSCT witho ut evidence of obstruction or mucositis. Hospitalization was frequentl y required for hydration. Gastroparesis was found in all four patients who underwent gastric emptying studies. The nausea and vomiting respo nded to the promotility drug cisapride and high dose corticosteroids. In Part II of the study, the authors found that PPNV was frequent; 24% of patients had significant nausea and 18% had significant vomiting 6 weeks after PSCT, despite treatment with standard antiemetics. CONCLU SIONS. PPNV is a frequent complication of high dose chemotherapy with the aforementioned regimen. It may be due to gastroparesis and represe nts a form of gastrointestinal toxicity to chemotherapy not previously reported. (C) 1997 American Cancer Society.