From the Guidelines
To ensure the patient is prepared for the peripheral blood stem cell transplant today, it is crucial to prioritize antiemetic prophylaxis, particularly with the addition of an NK 1 receptor antagonist, as evidenced by the study published in the Journal of Clinical Oncology in 2017 1. This preparation is vital to prevent nausea and vomiting, which are common side effects of the high-dose chemotherapy conditioning regimen. The patient should undergo a comprehensive medical evaluation, including blood tests, heart and lung function tests, and imaging studies to ensure they can tolerate the procedure. Prior to transplant, the patient will receive a conditioning regimen, typically consisting of high-dose chemotherapy (such as cyclophosphamide, busulfan, or melphalan) and possibly total body irradiation to eliminate diseased cells and create space for new stem cells. This conditioning phase usually occurs 5-10 days before the transplant. Patients also need a central venous catheter placement for medication administration and blood draws. Anti-infection prophylaxis is essential, including antibiotics (like ciprofloxacin or levofloxacin), antifungals (fluconazole or posaconazole), and antivirals (acyclovir or valacyclovir), as recommended by guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients 1. The patient should arrange for a caregiver to assist during recovery, as the procedure requires a hospital stay of 2-4 weeks followed by close outpatient monitoring. Psychological preparation is important as patients may experience side effects like nausea, fatigue, and risk of infection during the neutropenic period. The conditioning regimen destroys bone marrow cells to make room for new stem cells, while also suppressing the immune system to prevent rejection of the transplanted cells, explaining why infection prevention is crucial during this vulnerable period. It is also important to note that the use of autologous platelet concentrates, as described in the 2025 study published in Periodontology 2000 1, is not directly relevant to the preparation for a peripheral blood stem cell transplant. Therefore, the focus should remain on the comprehensive medical evaluation, conditioning regimen, anti-infection prophylaxis, and psychological preparation to ensure the best possible outcome for the patient. Key considerations include:
- Comprehensive medical evaluation
- Conditioning regimen with high-dose chemotherapy and possibly total body irradiation
- Central venous catheter placement
- Anti-infection prophylaxis
- Psychological preparation
- Arrangement for a caregiver during recovery
- Monitoring for side effects during the neutropenic period.
From the Research
Preparations for Peripheral Blood Stem Cell Transplant
To ensure the patient is prepared for the peripheral blood stem cell transplant, several steps can be taken:
- Review the patient's medical history and current medications to identify any potential interactions or complications 2, 3, 4, 5, 6
- Administer antiemetic medications as prescribed to prevent nausea and vomiting, such as granisetron, prochlorperazine, and dexamethasone 2, or palonosetron and dexamethasone 3
- Consider the use of aprepitant in combination with other antiemetic medications to prevent delayed nausea and vomiting 4, 6
- Monitor the patient's vital signs and overall health status closely before, during, and after the transplant procedure
- Ensure the patient has a clear understanding of the transplant process, potential side effects, and follow-up care instructions
Antiemetic Regimens
Different antiemetic regimens have been studied for their effectiveness in preventing nausea and vomiting in patients undergoing peripheral blood stem cell transplants, including:
- Oral granisetron, prochlorperazine, and dexamethasone 2
- Palonosetron and dexamethasone 3
- Aprepitant in combination with ondansetron and dexamethasone 4
- Oral ondansetron, oral granisetron, or IV ondansetron 5
- Aprepitant as part of the antiemetic regimen for high-dose melphalan conditioning 6
Patient Education and Support
It is essential to provide the patient with comprehensive education and support throughout the transplant process, including:
- Clear explanations of the transplant procedure and potential side effects
- Instructions on how to manage nausea and vomiting
- Information on follow-up care and appointments
- Emotional support and counseling as needed