title: Outpatient high-dose melphalan in multiple myeloma patients.
abstract: 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.
authors.affiliation: Section of Medical Oncology, Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut 06510, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Kassar
authors.forename: Erin
authors.initials: E
authors.lastname: Medoff
authors.forename: Stuart
authors.initials: S
authors.lastname: Seropian
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Cooper
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D018906:Antineoplastic Agents, Alkylating; D002443:Ceftriaxone; D008558:Melphalan