Prevention of Dimethylsulfoxide-Related Nausea and Vomiting by Prophylactic Administration of Ondansetron for Patients Receiving Autologous Cryopreserved Peripheral Blood Stem Cells

Seth Eisenberg

Mihkaila M. Wickline

Michael Linenberger

Ted Gooley

Leona Holmberg

peripheral blood stem cell transplantation, nausea/vomiting, adverse event
ONF 2013, 40(3), 285-292. DOI: 10.1188/13.ONF.285-292

Purpose/Objectives: To evaluate the effectiveness of ondansetron for the prevention of nausea and vomiting from dimethylsulfoxide (DMSO) during autologous stem cell transplantation (ASCT) infusion.

Design: Nonrandomized cohort using historical control.

Setting: Comprehensive cancer center outpatient infusion department.

Sample: 50 patients receiving ASCT in the outpatient setting.

Methods: Patients were assessed for nausea and vomiting on their infusion day using the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) at arrival, pre-ASCT infusion, pre-ondansetron administration, prior to the first bag, and after each bag of stem cells. A standard script was used to ensure consistency. Ondansetron, 16 mg IV, was administered 30-90 minutes prior to each ASCT infusion. Number and volume of stem cells bags, as well as infusion rate and emesis episodes, were recorded. Nausea scores and vomiting episodes were compared to historical data.

Main Research Variables: Subjectivity of nausea, potential Hawthorne Effect.

Findings: Forty-five percent of patients had an MAT score greater than 2 on arrival, decreasing to 18% after receiving ondansetron before the first bag. Twenty-four percent had MAT increases of more than two points by infusion end compared to 58% in the historic control group. Eighteen percent of patients vomited compared to 28% of historic controls.

Conclusions: The administration of 16 mg of IV ondansetron significantly reduced DMSO-related nausea and episodes of vomiting in patients receiving ASCT.

Implications for Nursing: Prophylactic administration of ondansetron had a positive effect on reducing nausea symptoms and episodes of vomiting during ASCT infusions. These results prompted a change in clinical practice. More research is required to determine whether the inclusion of other antiemetic agents would provide even greater benefit.

Knowledge Translation: To date, no other published studies have explored the benefits of premedicating patients with ondansetron prior to ASCT infusions. This study is the first to establish efficacy of ondansetron for an unlabeled indication. These results may pave the way for future research in decreasing nausea and vomiting in this setting.

Jump to a section


    Abrahamsen, J. F., Rusten, L., Bakken, A. M., & Bruserud, Ø. (2004). Better preservation of early hematopoietic progenitor cells when human peripheral blood progenitor cells are cryopreserved with 5% dimethylsulfoxide instead of 10% dimethylsulfoxide. Transfusion, 44, 785-789.
    Berz, D., McCormack, E. M., Winer, E. S., Colvin, G. A., & Quesenberry, P. J. (2007). Cryopreservation of hematopoietic stem cells. American Journal of Hematology, 82, 463-472. doi:10.1002/ajh.20707
    Bojanic, I., Cepulic, B. G., Mazic, S., Batinic, D., Nemet, D., & Labar, B. (2008). Toxicity related to autologous peripheral blood haematopoietic progenitor cell infusion is associated with number of granulocytes in graft, gender and diagnosis of multiple myeloma. Vox Sanguinis, 95(1), 70-75. doi:10.1111/j.1423-0410.2008.01060.x
    Calmels, B., Lemarié, C., Esterni, B., Malugani, C., Charbonnier, A., Coso, D., … Chabannon, C. (2007). Occurrence and severity of adverse events after autologous hematopoietic progenitor cell infusion are related to the amount of granulocytes in the apheresis product. Transfusion, 47, 1268-1275.
    Campbell-Yeo, M., Ranger, M., Johnston, C., & Fergusson, D. (2009). Controlling bias in complex nursing intervention studies: A checklist. Canadian Journal of Nursing Research, 41(4), 31-50.
    Comeau, T. B., Epstein, J. B., & Migas, C. (2001). Taste and smell dysfunction in patients receiving chemotherapy: A review of current knowledge. Supportive Care in Cancer, 9, 575-580.
    Donmez, A., Tombuloglu, M., Gungor, A., Soyer, N., Saydam, G., & Cagirgan, S. (2007). Clinical side effects during peripheral blood progenitor cell infusion. Transfusion and Apheresis Science, 36(1), 95-101. doi:10.1016/j.transci.2006.05.019
    Egerer, G., Eisenlohr, K., Gronkowski, M., Burhenne, J., Riedel, K. D., & Mikus, G. (2010). The NK receptor antagonist aprepitant does not alter the pharmacokinetics of high-dose melphalan chemotherapy in patients with multiple myeloma. British Journal of Clinical Pharmacology, 70, 903-907. doi:10.1111/j.1365-2125.2010.03792.x
    Egorin, M. J., Rosen, D. M., Sridhara, R., Sensenbrenner, L., & Cottler-Fox, M. (1998). Plasma concentrations and pharmacokinetics of dimethylsulfoxide and its metabolites in patients undergoing peripheral-blood stem cell transplants. Journal of Clinical Oncology, 16, 610-615.
    Ferrucci, P. F., Martinoni, A., Cocorocchio, E., Civelli, M., Cinieri, S., Cardinale, D., … Martinelli, G. (2000). Evaluation of acute toxicities associated with autologous peripheral blood progenitor cell reinfusion in patients undergoing high-dose chemotherapy. Bone Marrow Transplantation, 25, 173-177.
    Gaylord, P. (2007). Dimethyl sulfoxide (DMSO) health and safety information (p. 16). Retrieved from
    Hawkins, R., & Grunberg, S. (2009). Chemotherapy-induced nausea and vomiting: Challenges and opportunities for improved patient outcomes. Clinical Journal of Oncology Nursing, 13, 54-64. doi:10.1188/09.CJON.54-64
    Hessell, P. G., Lloyd-Jones, J. G., Muir, N. C., Parr, G. D., & Sugden, K. (1989). A comparison of the availability of prochlorperazine following i.m. buccal and oral administration. International Journal of Pharmaceutics, 52, 159-164.
    Jacob, S. W., & de la Torre, J. C. (2009). Pharmacology of dimethyl sulfoxide in cardiac and CNS damage. Pharmacological Reports, 61, 225-235.
    Jokela, R. M., Cakmakkaya, O. S., Danzeisen, O., Korttila, K. T., Kranke, P., Malhotra, A., … Apfel, C. C. (2009). Ondansetron has similar clinical efficacy against both nausea and vomiting. Anaesthesia, 64, 147-151. doi:10.1111/j.1365-2044.2008.05732.x
    Kessinger, A., Schmit-Pokorny, K., Smith, D., & Armitage, J. (1990). Cryopreservation and infusion of autologous peripheral blood stem cells. Bone Marrow Transplantation, 5(Suppl. 1), 25-27.
    Kessinger, A., & Sharp, J. G. (2003). The whys and hows of hematopoietic progenitor and stem cell mobilization. Bone Marrow Transplantation, 31, 319-329.
    Khera, N., Jinneman, J., Storer, B. E., Heimfeld, S., O'Meara, M. M., Chauncey, T. R., … Linenberger, M. (2012). Limiting the daily total nucleated cell dose of cryopreserved peripheral blood stem cell products for autologous transplantation improves infusion-related safety with no adverse impact on hematopoietic engraftment. Biology of Blood and Marrow Transplantation, 18, 220-228. doi:10.1016/j.bbmt.2011.06.003
    Kim, D. H., Jamal, N., Saragosa, R., Loach, D., Wright, J., Gupta, V., … Messner, H. A. (2007). Similar outcomes of cryopreserved allogeneic peripheral stem cell transplants (PBSCsT) compared to fresh allografts. Biology of Blood and Marrow Transplantation, 13, 1233-1243. doi:10.1016/j.bbmt.2007.07.003
    Liseth, K., Ersvær, E., Abrahamsen, J. F., Nesthus, I., Ryningen, A., & Bruserud, Ø. (2009). Long-term cryopreservation of autologous stem cell grafts: A clinical and experimental study of hematopoietic and immunocompetent cells. Transfusion, 49, 1709-1719. doi:10.1111/j.1537-2995.2009.02180.x
    Micromedex. (2010). Dimethyl sulfoxide. Retrieved from
    Micromedex. (2012). Lorazepam. Retrieved from
    Milone, G., Mercurio, S., Strano, A., Leotta, S., Pinto, V., Battiato, K., … Giustolisi, R. (2007). Adverse events after infusions of cryopreserved hematopoietic stem cells depend on non-mononuclear cells in the infused suspension and patient age. Cytotherapy, 9, 348-355. doi:10.1080/14653240701326756
    Molassiotis, A., Coventry, P. A., Stricker, C. T., Clements, C., Eaby, B., Velders, L., … Gralla, R. J. (2007). Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: The MASCC antiemesis tool. Journal of Pain and Symptom Management, 34, 148-159. doi:10.1016/j.jpainsymman.2006.10.018
    Okamoto, Y., Takaue, Y., Saito, S., Shimizu, T., Suzue, T., Abe, T., … Kawano, Y. (1993). Toxicities associated with cryopreserved and thawed peripheral blood stem cell autografts in children with active cancer. Transfusion, 33, 578-581.
    Pasquini, M. C., & Wang, Z. (2011). Current use and outcome of hematopoietic stem cell transplantation: CIBMTR Summary Slides, 2011. Retrieved from
    Potter, P., Eisenberg, S., Cain, K. C., & Berry, D. L. (2011). Orange interventions for symptoms associated with dimethyl sulfoxide during stem cell reinfusions: A feasibility study. Cancer Nursing, 34, 361-368. doi:10.1097/NCC.0b013e31820641a5
    Prior, D., Mitchell, A., Nebauer, M., & Smith, M. (2000). Oncology nurses' experience of dimethyl sulfoxide odor. Cancer Nursing, 23, 134-140.
    Quigley, E. M., Hasler, W. L., & Parkman, H. P. (2001). AGA technical review on nausea and vomiting. Gastroenterology, 120(1), 263-286.
    Rowley, S., MacLeod, B., Heimfeld, S., Holmberg, L., & Bensinger, W. (1999). Severe central nervous system toxicity associated with the infusion of cryopreserved PBSCs components. Cytotherapy, 1, 311-317.
    Sauer-Heilborn, A., Kadidlo, D., & McCullough, J. (2004). Patient care during infusion of hematopoietic progenitor cells. Transfusion, 44, 907-916.
    Simons, K. J., Watson, W. T., Martin, T. J., Chen, X. Y., & Simons, F. E. (1990). Diphenhydramine: Pharmacokinetics and pharmacodynamics in elderly adults, young adults, and children. Journal of Clinical Pharmacology, 30, 665-671.
    Stroncek, D. F., Fautsch, S. K., Lasky, L. C., Hurd, D. D., Ramsay, N. K., & McCullough, J. (1991). Adverse reactions in patients transfused with cryopreserved marrow. Transfusion, 31, 521-526.
    Syme, R., Bewick, M., Stewart, D., Porter, K., Chadderton, T., & Glück, S. (2004). The role of depletion of dimethyl sulfoxide before autografting: On hematologic recovery, side effects, and toxicity. Biology of Blood and Marrow Transplantation, 10, 135-141.
    Tompkins Stricker, C., & Eaby, B. (2010). Chemotherapy-induced nausea and vomiting. In C. Brown (Ed.), A guide to oncology symptom management (pp. 91-122). Pittsburgh, PA: Oncology Nursing Society.
    Zambelli, A., Poggi, G., Da Prada, G., Pedrazzoli, P., Cuomo, A., Miotti, D., … Robustelli della Cuna, G. (1998). Clinical toxicity of cryopreserved circulating progenitor cells infusion. Anticancer Research, 18(6B), 4705-4708.