Autologous stem cell transplant in 716 patients with multiple myeloma: low treatment-related mortality, feasibility of outpatient transplant, and effect of a multidisciplinary quality initiative.
We report on the feasibility of outpatient transplant in 716 patients undergoing autologous stem cell transplant for multiple myeloma at Mayo Clinic's site in Rochester, MN, from January 1, 2000, through October 31, 2007. We also report on the development and effect of a multidisciplinary quality initiative implemented by the Mayo Clinic Blood and Marrow Transplant Program involving physicians, nurses, pharmacists, dietitians, and financial specialists for outpatient management of patients undergoing stem cell transplant. This approach uses an electronic ordering system for diagnostic tests and chemotherapy to minimize medical errors. Analysis of hospitalization trends since inception of the program showed that 278 (39%) of the 716 patients treated completed the transplant procedure as outpatients. The median duration of hospitalization for all patients was 4 days; age and serum creatinine levels were predictive of the need for and duration of hospitalization. We also assessed recent treatment-related mortality rates during a 33-month period after implementation of the program (between January 1, 2005, and October 1, 2007). The 100-day survival rate was 99.5% for patients with low-risk myeloma (transplant during first plateau; n=201) and 97.2% for patients with high-risk myeloma (refractory, relapsing or second or greater plateau; n=71). The overall 100-day survival rate was 98.9%. Our experience shows that outpatient transplant is feasible for all patients with multiple myeloma and results in shorter hospital stays and low treatment-related mortality rates.
Gertz
Morie A
MA
Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. gertz.morie@mayo.edu
Ansell
Stephen M
SM
Dingli
David
D
Dispenzieri
Angela
A
Buadi
Francis K
FK
Elliott
Michelle A
MA
Gastineau
Dennis A
DA
Hayman
Suzanne R
SR
Hogan
William J
WJ
Inwards
David J
DJ
Johnston
Patrick B
PB
Kumar
Shaji
S
Lacy
Martha Q
MQ
Leung
Nelson
N
Micallef
Ivana N M
IN
Porrata
Luis F
LF
Schafer
Barbara A
BA
Wolf
Robert C
RC
Litzow
Mark R
MR
D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009101:Multiple Myeloma / Q000401:mortality / Q000601:surgery*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014182:Transplantation, Autologous