title: Autologous hematopoietic stem cell transplants that utilize total body irradiation can safely be carried out entirely on an outpatient basis.
abstract: Outpatient hematopoietic stem cell transplants (HSCT) are usually performed in patients receiving minimally mucotoxic preparative regimens; total body irradiation (TBI)-based regimens typically are excluded. To improve resource utilization and patient satisfaction, we developed a totally outpatient HSCT program for TBI regimens and compared outcomes for our first 100 such transplants to 32 performed as in-patients during the same interval, for caregiver or financial reasons. Symptoms were managed predominately with oral agents; pain management consisted of transdermal fentanyl and oral morphine solution. Except for more unmarried in-patients, the two groups were matched. Time to engraftment, severity of mucositis and transplant duration were identical for the two groups. Twenty-seven of the outpatients were admitted (median-6 days), primarily for progressing infection. Thus 92% of all transplant days were outpatient. There were no septic episodes or hospital admissions for pain management. There were no deaths to day 30 in either group and 100-day survival was identical. There was a mean cost savings of Dollars 16,000 per outpatient transplant and outpatient patient/caregiver quality of life was similar to that reported for in-patients. Patients undergoing severely mucotoxic regimens can be safely transplanted in an outpatient setting with a significant cost saving, with no increase in morbidity or mortality.
authors.affiliation: Bone Marrow Transplant Program, Loyola University Medical Center, Maywood, IL 60153, USA. pstiff@lumc.edu
authors.forename: P
authors.initials: P
authors.lastname: Stiff
authors.forename: P
authors.initials: P
authors.lastname: Mumby
authors.forename: L
authors.initials: L
authors.lastname: Miler
authors.forename: T
authors.initials: T
authors.lastname: Rodriguez
authors.forename: M
authors.initials: M
authors.lastname: Parthswarthy
authors.forename: K
authors.initials: K
authors.lastname: Kiley
authors.forename: N
authors.initials: N
authors.lastname: Porter
authors.forename: R
authors.initials: R
authors.lastname: Batiste
authors.forename: S
authors.initials: S
authors.lastname: Wojtowitz
authors.forename: S
authors.initials: S
authors.lastname: Lichtenstein
authors.forename: M
authors.initials: M
authors.lastname: Fox-Geiman
authors.forename: A
authors.initials: A
authors.lastname: Toor
mesh_terms: D000328:Adult; D017046:Cost Savings; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010045:Outpatients; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D011788:Quality of Life; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation / Q000009:adverse effects / Q000379:methods*