Online First

Original Article

International Survey for Antiemetics in Hematopoietic Stem Cell Transplantation in the APBMT Centers

Kimikazu Yakushijin¹, Jacinta Perram², Aloysius Ho³, Tasneem Farzana⁴, Hiroatsu Iida⁵, Jong Wook Lee⁶, Yoshihiro Inamoto⁷, Biju George⁸, Depei Wu⁹, Ritsuro Suzuki¹⁰, Maryam Behfar^11,12, He Huang¹³, Thiti Asawapanumas¹⁴, Philip Rowlings¹⁵, Bishesh S. Poudyal¹⁶, Damai Santosa¹⁷, Aye Aye Gyi¹⁸, Otgonbat Altangerel¹⁹, Chinadol Wanitpongpun²⁰, Gin Gin Gan²¹, Satoshi Iyama²², Shahid Iqbal²³, Mani Ramzi²⁴, Alka Khadwal²⁵, Jun Kato²⁶, Joycelyn Sim²⁷, Jessica Cheng², David Ma², Yi Xuan Chua²⁸, Shinichiro Okamoto²⁶, Minako Iida²⁹, Shigeo Fuji³⁰

¹Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan

²Haematology and Bone Marrow Transplant, St Vincent's Hospital Sydney, Sydney, NSW, Australia

³Haematology, Singapore General Hospital, Singapore, Singapore

⁴BMT, National Institute of blood diseases and bone marrow transplantation (Lahore campus), Karachi, Pakistan

⁵Hematology/Cell Therapy, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

⁶Hematology-Oncology, Hanyang University Seoul Hospital, Seoul, Republic of Korea

⁷Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

⁸Department of Haematology, Christian Medical College Vellore, Vellore, India

⁹Department of Hematology, the First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China

¹⁰Hematology and Oncology, Shimane University, Izumo, Japan

¹¹Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute, Tehran, Iran

¹²Children's Medical Center, Pediatrics Center of Excellence, TUMS, Tehran, Iran

¹³Bone Marrow Transplantation Center, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

¹⁴Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

¹⁵Haematology, Calvary Mater Newcastle, Waratah, Australia

¹⁶Clinical hematology and bone marrow transplant, Civil Service Hospital, Kathmandu, Nepal

¹⁷Division of Hematology Medical Oncology, Department of Internal Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia

¹⁸Department of Clinical Haematology, North Okkalapa General Hospital, Yangon, Myanmar

¹⁹Department of Hematology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia

²⁰Internal Medicine, Srinagarind, Khon Kaen University Hospital, Khon Kaen, Thailand

²¹Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

²²Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan

²³Bone Marrow Transplant Data Management Section, Armed Forces Bone Marrow Transplant Centre (AFBMTC), Rawalpindi, Pakistan

²⁴Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

²⁵Clinical Hematology & Medical Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, India

²⁶Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

²⁷Department of Medicine, Queen Mary Hospital, Hong Kong, China

²⁸Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore

²⁹Promotion for Blood and Marrow Transplantation, Aichi Medical University, School of Medicine, Nagakute, Japan

³⁰Hematology, Osaka International Cancer Institute, Osaka, Japan

Keywords

antiemetics, international survey, chemotherapy-induced nausea and vomiting

Submitted: September 1, 2025

Accepted: October 22, 2025

Published online: January 9, 2026

DOI: https://doi.org/10.31547/bct-2025-020

Abstract

Antiemetic therapy is an essential component of supportive care following hematopoietic stem cell transplantation (HSCT). Chemotherapy and irradiation used in conditioning regimens frequently induce severe nausea and vomiting, which can significantly impair patients' quality of life. Although recent guidelines recommend a triple combination of a 5-hydroxytryptamine-3 (5-HT₃) receptor antagonist, dexamethasone, and an neurokinin 1 (NK1) receptor antagonist, antiemetic practices vary widely across countries and regions. This study aimed to investigate current antiemetic policies among the Asia-Pacific Blood and Marrow Transplantation (APBMT) centers.

A web-based questionnaire survey using SurveyMonkey was distributed via email from the APBMT office between December 7, 2021, and January 21, 2022. The survey addressed antiemetic strategies used in HSCT conditioning regimens. Responses were received from 28 centers across 14 countries.

Among the participating centers, 93% reported that physicians were primarily responsible for antiemetic decision-making, with limited involvement from pharmacists or multidisciplinary teams. The most commonly used conditioning regimens for allogeneic HSCT were busulfan and cyclophosphamide (Bu-CY) (72%) and fludarabine and busulfan (Flu-Bu) (62%), whereas high-dose melphalan (83%) and carmustine (BCNU), etoposide, cytarabine arabinoside, and melphalan (BEAM) (69%) were predominant for autologous HSCT. Despite guidelines recommending olanzapine as an additional antiemetic in highly emetogenic chemotherapy, its routine implementation remains limited, even in high-risk settings. Notably, dexamethasone is frequently avoided in allogeneic HSCT, likely due to concerns about its immunosuppressive effects. The incidence of vomiting varied, with 36% of centers reporting rates of 10% or higher, even among those with institutional antiemetic policies.

In conclusion, this survey highlighted substantial variation in antiemetic strategies across the APBMT centers. The limited use of olanzapine reflects ongoing concerns regarding its side effects, while the frequent avoidance of dexamethasone in allogeneic HSCT represents a deviation from current guideline recommendations. Given the complexity of HSCT and the varying side effect profiles of antiemetic agents, a multidisciplinary approach to treatment planning, including that of pharmacists and dietitians, could optimize supportive care. Future prospective studies are warranted to evaluate the safety, efficacy, and feasibility of olanzapine- and steroid-sparing antiemetic strategies to improve patient outcomes.

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