Outpatient high-dose melphalan in multiple myeloma patients.
BACKGROUND
The brief period of neutropenia and limited nonmarrow toxicity after high-dose melphalan (HDM) provide a rationale for outpatient treatment.


METHODS
Our experience with HDM (140-200 mg/m(2)) in 90 consecutive transplant episodes was retrospectively reviewed. Most patients were treated in an outpatient setting. Patients without a primary care provider (PCP) were electively admitted before the anticipated onset of neutropenia. Ceftriaxone was added to ciprofloxacin at the onset of neutropenia. All febrile patients were admitted.


RESULTS
The median time from peripheral blood progenitor cell infusion to onset of neutropenia was 5 days (range, 4-6 days), and the mean duration of neutropenia was 5 days (range, 4-7 days). Thirty-eight transplants (42%) were performed entirely in the outpatient setting. The mean duration of hospitalization was 2.2 days in patients not electively admitted. The use of ceftriaxone was associated with a decreased risk for fever (39% vs. 79%) and reduced duration of hospitalization (1.6 days vs. 4.5 days) for nonelectively admitted patients. There was no treatment-related mortality.


CONCLUSIONS
Ambulatory therapy with HDM is safe and can be achieved in a general outpatient setting. The predictable time to neutropenia allows even poor candidates for outpatient therapy to be admitted electively on Day +4. The apparent beneficial effect of ceftriaxone needs to be confirmed in randomized trials.
Kassar
Mohamad
M
Section of Medical Oncology, Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut 06510, USA.
Medoff
Erin
E
Seropian
Stuart
S
Cooper
Dennis L
DL
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology; D002443:Ceftriaxone / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005334:Fever / Q000453:epidemiology / Q000517:prevention & control; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000628:therapy; D009503:Neutropenia / Q000139:chemically induced / Q000628:therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology; D033581:Stem Cell Transplantation
D000900:Anti-Bacterial Agents; D018906:Antineoplastic Agents, Alkylating; D002443:Ceftriaxone; D008558:Melphalan