100 / 154
S70
A B S T R A C T S
metabolism. Thus, treatment and complications after HSCT
exert large negative effects on lean muscle mass, especially
in elderly patients.
Objectives:
The aim of this study is to determine whether
measures of body composition predict outcomes after HSCT
within the context of an older population.
Methods:
We performed a retrospective longitudinal
study through review of medical records of 48 patients
60
years undergoing HSCT at Hospital Israelita Albert Einstein,
from 2013 to 2015, with tomography scans (CTs) in their
clinical course within 60 days before or 15 days after HSCT.
Body composition data were analyzed in CTs in T4 level by
Sliceomatic
®
program. Descriptive statistics were calculated
by SSPS program for age, body mass index, hand grip and
corporal composition parameters.
Results:
Of the 48 patients evaluated, 24 were male. The
median age was 67 years (±4.2). In relation to underlying
disease, it was observed that 35.4% had a diagnosis of
multiple myeloma, 18.8% of myelodysplastic syndrome, 14.6%
of lymphoma, 10.4% of myeloid leukemia acute and 10.8%
between the diagnoses a lower proportion as amyloidosis,
cutaneous lymphoma and lymphocytic lymphoma. Regarding
the type of HSCT, 50% was autologous, 45.8% was allogeneic
and 4.2% was haplodidentical. In relation to body mass
index (BMI), 45.8% of patients were in the normal range,
21% overweight and 5% considered underweight. The Hand
Grip median was 29 kgf (±9.2). Of the 48 patients evaluated,
neutrophil engraftment had a median of 13 days (±4.3); 17
patients had acute GVHD, 9 Grade I-II and 8 with Grade III-
IV. 60.4% of patients are alive, of the 19 deaths, 10 were not
related to relapse. CTs evaluation found an average muscle
area of 151cm
2
(±41) and subcutaneous adipose tissue of
230.5 cm
2
(±78). The only positive correlation was found
between neutrophil engraftment and subcutaneous adipose
tissue (r=0.8, p<0.05).
Conclusion:
This study has limitations due to the small
number of patients. However, we conclude that the reduction
of toxicity related to HSCT through the analysis of body
composition by CT scans is an emerging area of research,
feasible, reliable and no charge to the patient, since CT scans
are part of the clinical routine of these patients. Identify a
reversible pre-transplant condition that is associated with
worse outcomes may allow intervention measures such
as greater nutritional support and exercise to improve pre-
transplant. In our older patient cohort undergoing HSCT
had a strong correlation between neutrophil engraftment
and subcutaneous adipose tissue. The assessment of body
composition for this group of patients may provide data
associated with prognosis changing nutritional and geriatric
practice for better results.
Disclosure of interest:
None declared
Keywords:
Body composition, elderly patients, hematopoietic
stem cell transplantation, sarcopenia
P059
EFFICACY AND SAFETY OF ROLAPITANT IN THE
PREVENTION OF CHEMOTHERAPY-INDUCED
NAUSEA AND VOMITING IN PATIENTS AGED <65
VERSUS
65 YEARS RECEIVING MULTIPLE CYCLES OF
EMETOGENIC CHEMOTHERAPY
M. Aapro
1,
*, D. Powers
2
, S. Arora
2
1
IMO Clinique de Genolier, Genolier, Switzerland,
2
Tesaro, Inc.,
Waltham, MA, USA
Introduction:
Although older patients (pts) may have less
chemotherapy-induced nausea and vomiting (CINV) than
younger pts, they may have more health complications. Thus,
preventative treatments with a good safety profile are needed.
Objectives:
To evaluate the efficacy and safety of the long-
acting NK-1 antagonist (RA) rolapitant added to 5-HT
3
RA and
dexamethasone over multiple cycles according to pt age (<65
vs
65 years).
Methods:
In 3 similarly-designed, randomized, placebo-
controlled phase 3 trials (n=1201 rolapitant and n=1201
control), pts received a single oral dose of 180 mg rolapitant
or placebo before receiving highly or moderately emetogenic
chemotherapy.Allptsreceivedanoral5-HT
3
RA+dexamethasone
(active control). Pts who completed cycle 1 could continue the
same antiemetic treatment in subsequent cycles. Endpoints for
cycle 1 of chemotherapy included complete response (CR; no
emesis and no use of rescue medication), no emesis, and no
nausea (maximum visual analogue scale [VAS] <5 mm), in the
overall (0–120 h), acute (
24 h), and delayed (
24–120 h) phases.
On days 6-8 of each subsequent chemotherapy cycle, pts self-
reported the incidence of emesis and nausea interfering with
normal daily life. Treatment-emergent adverse events (TEAEs)
were recorded in all pts and compared between rolapitant
and control arms. Data from the 3 pooled trials were analyzed
according to pt age.
Results:
CR was significantly higher with rolapitant in both
age groups in all phases (P<0.05; table). Rates of no nausea
were significantly higher with rolapitant in both age groups in
the overall (<65: 45.5% vs 39.2%, P=0.007;
65: 57.3% vs 48.8%,
P=0.031) and delayed phase (<65: 49.1% vs 42.3%, P=0.004;
65:
59.2% vs 50.6%; P=0.028). Although less pts were available for
follow up in each subsequent cycle, rolapitant continued to
provide significant additional protection against CINV and this
effect reached statistical significance (P<0.05) for no emesis in
cycles 2, 3, 5, 6 for pts <65 years and in cycles 2, 4, 5 for pts
65
years. The incidence of TEAEs across all cycles was similar in
the rolapitant and active control arms in both age groups, but
was higher in pts
65 years in both treatment arms.
Conclusion:
Pts <65 years had a lower incidence of CR in
the rolapitant and control arms across all phases than pts
65
years. The trend towards higher incidence of CINV in pts <65
is consistent with previously published reports establishing
age as a pt-related risk factor. In pts aged <65 and
65 years
who received multiple cycles of emetogenic chemotherapy
rolapitant improved CINV control when added to 5-HT
3
RA
and dexamethasone therapy, and was safe and well-tolerated.
This supports the benefit of rolapitant as an antiemetic and
reinforces the need to target both the serotonin and substance
P pathways for durable prevention of CINV in both age groups.