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 well recognized complication of cancer drug treatment; it is usually short-lived and controllable by modem antiemetics. The authors report a high incidence of prolonged nausea and vomiting after high dose chemotherapy with autologous peripheral stem cell transplantation (PSCT) in the treatment of high risk breast carcinoma patients.

METHODS: Patients with high risk breast carcinoma were conditioned with high dose carmustine, cisplatin, and cyclophosphamide followed by autologous PSCT. In Part I of the study, patients who received PSCT at UCLA Medical Center were identified if they were either readmitted with dehydration secondary to nausea and vomiting or referred to a gastroenterology specialist for the treatment of intractable nausea and vomiting. In Part II of the study, the authors examined a series of 38 women treated at UCLA Medical Center in 1993 for high risk breast carcinoma to determine the incidence of prolonged postchemotherapy nausea and vomiting (PPNV) after PSCT. These women were followed at 2-week intervals with a quality 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 without evidence of obstruction or mucositis. Hospitalization was frequently required for hydration. Gastroparesis was found in all four patients who underwent gastric emptying studies. The nausea and vomiting responded 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.

CONCLUSIONS: PPNV is a frequent complication of high dose chemotherapy with the aforementioned regimen. It may be due to gastroparesis and represents a form of gastrointestinal toxicity to chemotherapy not previously reported.