Supportive Care Measures for Patients Planning to Receive an Allogenic Transplant

This is a video synopsis/summary of a Peer Exchange featuring Miguel-Angel Perales, MD; Nelli Bejanyan, MD; Amandeep Salhotra, MD; and Arpita Gandhi, MD, MS.

The panel discusses the supportive care measures that can help mitigate the toxicities associated with myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT). Gastrointestinal toxicities, such as nausea, vomiting, and mucositis, are common complications that can be managed with a combination of steroids, benzodiazepines, and fosaprepitant. Palifermin (keratinocyte growth factor) is available for patients receiving total body irradiation–based conditioning to manage mucositis. Diarrhea can be addressed with adequate hydration and antimotility agents like octreotide and lomotil.

The panel also emphasizes the importance of addressing the mental health of patients undergoing transplantation, as they are often confined to the hospital for extended time periods and separated from friends and family. Counseling, support from clinical social workers, and low-intensity interventions like physical and occupational therapy can improve patient outcomes and facilitate early discharge.

Advancements in anti-infection control have substantially improved over time, with better antifungal prophylaxis and the use of letermovir to control cytomegalovirus (CMV) reactivation, particularly in patients receiving post-transplant cyclophosphamide for graft-vs-host disease prophylaxis. Real-world experience with letermovir has shown even better results than clinical trial data, and recent studies suggest that extending letermovir prophylaxis to 200 days in high-risk patients can further delay CMV reactivation.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.