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Aim Chemotherapy-induced nausea and vomiting (CINV) remains a significant challenge in bone marrow transplant (BMT) patients. Aprepitant, a neurokinin-1 (NK1) receptor antagonist, is widely used for CINV prevention in specific regimens, but its broader effects on liver function tests (LFTs) and neutrophil recovery post-BMT remain unclear. 1–3 This audit investigates the effectiveness of an extended aprepitant regimen, in combination with other anti-emetics, outside its usual recommendation for vomiting resolution, as well as its potential impact on LFTs and neutrophil recovery at day 28 post-transplant.Methods A retrospective audit was conducted on all paediatric BMT patients treated between 31/03/2023 and 31/05/2024, identifying 39 patients through the CMM® dispensing system. Of these, 23 patients received aprepitant during admission, and only those on extended courses (≥3 doses per week) were evaluated (n=19). Data on CINV resolution, LFT parameters (alanine transaminase (ALT), aspartate transaminase (AST) and bilirubin), and neutrophil recovery on day 28 ± 1–2 days were analysed.Results Vomiting was resolved in 94.7% (n=18) of patients. One patient exhibited a mildly elevated ALT but without any significant changes in bilirubin level. This patient, however, has a complex background of post-transplant lymphoproliferative disorder (PTLD) induced by Epstein-Bar virus (EBV) in addition to his BMT and cytomegalovirus (CMV) infection, which ultimately led to death. No adverse effects on AST or bilirubin levels were observed in the subset of patients with available data (AST n=10; bilirubin n=19). Neutrophil recovery (defined as neutrophils >0.5 x 109/L at day 28 ± 1/2 day(s)) was 100%, indicating no adverse impact on bone marrow function.Conclusions The extended use of aprepitant in combination with other anti-emetics outside its usual recommendation is highly effective in resolving vomiting in BMT patients, with minimal adverse effects on liver function and no observed impact on neutrophil recovery. Further studies with larger sample sizes are warranted to confirm these findings and assess the long-term safety of this regimen.References Sandoz Limited. Aprepitant 125mg hard capsules [Internet]. 2020 [cited 2025 Feb 13]. Available from: https://www.medicines.org.uk/emc/product/11332/smpc#grefChildren’s Cancer and Leukaemia Group (CCLG). CCLG Guideline for the Management of Chemotherapy-Induced Nausea and Vomiting (CINV) [Internet]. 2023 [cited 2025 Feb 13].Kang, HJ, et al. Aprepitant for the prevention of chemotherapy-induced nausea and vomiting in children: a randomised, double-blind, phase 3 trial. The Lancet Oncology 2015;16(4):385–394.