Microbial and metabolic determinants of chemotherapy induced nausea and vomiting :A systems-level multi-omics investigation into gut-derived biological pathways influencing chemotherapy induced nausea and vomiting in stem cell transplant patients-A prospective observational study

Chemotherapy induced nausea and vomiting continues to be a significant distressing complication in patients undergoing hematopoietic stem cell transplantation. The prevalence of break through CINV in up to half of such patients not only impairs quality of life but also affects treatment, nutritional status, recovery outcomes. Recent insights into the gut brain axis suggests that the gut microbiome plays a critical role in modulating chemotherapy related toxicities, including emetic responses. Chemotherapy disrupts the gut microbial ecosystem, alters metabolite production and promotes inflammation. All of which may influence nausea and vomiting pathways. While emerging studies in solid tumors highlight the potential link between microbiota and CINV, there is currently no data specific to the hematopoietic stem cell transplantation. Given this context, investigating the microbiome CINV relationship in these patients is both timely and necessary. This study will fill a critical knowledge gap by identifying microbiota and metabolic signatures predicting of CINV, laying the groundwork for future personalized, microbiome targeted anti emetic interventions that may ultimately improve clinical outcomes and patient well being during transplantation.