THE USE OF THE ANTIEMETIC AKYNZEO FOR AUTOLOGOUS

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THE USE OF THE ANTI-EMETIC AKYNZEO FOR AUTOLOGOUS STEM CELL TRANSPLANT PATIENTS RECEIVING HIGH

THE USE OF THE ANTI-EMETIC AKYNZEO FOR AUTOLOGOUS STEM CELL TRANSPLANT PATIENTS RECEIVING HIGH DOSE MELPHALAN Dr Rachel Hall Lisa Hammond, CNS Royal Bournemouth Hospital

Rationale for pilot study Royal Bournemouth Hospital JACIE accredited autologous SCT unit. Small, approx

Rationale for pilot study Royal Bournemouth Hospital JACIE accredited autologous SCT unit. Small, approx 25 transplants annually Mostly HDM for Myeloma Anti-emetic protocol: ondansetron, metaclopromide PRN: Dexa, cyclizine, levopromethazine sc/pumps etc Noticed a high proportion of patients having sc pumps Nursing time, sc site infection risk, drowsiness

Akynzeo capsules 300 mg netupitant and 0. 5 mg palonosetron Dexamethasone 12 mg po

Akynzeo capsules 300 mg netupitant and 0. 5 mg palonosetron Dexamethasone 12 mg po D 1 and 8 mg po D 2 -4 Given 1 hour prior to melphalan infusion No renal/hepatic dose reductions Prolonged QT interval – avoid use with other indicated drugs Avoid with CYP 3 A 4 inducers as will decrease concentrations Cost £ 59

Pilot study Changed to Akynzeo regimen in all ASCT patients July 2016 All HDM

Pilot study Changed to Akynzeo regimen in all ASCT patients July 2016 All HDM patients had just Akynzeo and dexa with prn metaclopromide BEAM patients had standard regimen until D-1 and Akynzeo pre-HDM no ondansetron until 5 days post akynzeo Analysed data for 2016 transplants (Jan-June standard regimen and July-Dec Akynzeo) using notes/drug charts etc. 24 patients.

Results of retrospective audit Average number days Standard antiemetic regimen Akynzeo regimen Nausea total

Results of retrospective audit Average number days Standard antiemetic regimen Akynzeo regimen Nausea total 4. 9 0. 79 grade 1 2. 85 1. 5 grade 2 2. 9 0. 08 Vomiting grade 1 2. 6 0. 08 reduced nutritional intake 8. 5 1. 84 subcut levopromethazine pump 8. 33 0 subcut pump site inflammation 0. 83 0 Ondansetron use 17. 21 0. 83 Metaclopromide use 14. 13 12. 69 length hospital admission 19. 83 17. 67

Conclusions Marked reduction in reported nausea, vomiting and reduced nutritional intake No use of

Conclusions Marked reduction in reported nausea, vomiting and reduced nutritional intake No use of sc levopromethazine pumps with Akynzeo Reduction in use of all other anti-emetics with Akynzeo Reduction in need to access central lines, setup sc pumps, reduction in nursing time and risk of infection Reduction in length of stay Changed ASCT anti-emetic protocol in all patients from 2017

Thank you AMGEN Roger Hudson, Haem/Oncology pharmacists, RBH Rebecca Brooks, apheresis nurse, RBH

Thank you AMGEN Roger Hudson, Haem/Oncology pharmacists, RBH Rebecca Brooks, apheresis nurse, RBH