title: Early discharge after high-dose melphalan and peripheral blood stem cell reinfusion in patients with hematological and non-hematological disease.
abstract: The purpose of this study was to analyse our experience of early discharge 2 days after high-dose melphalan (HDM) (Day-1) followed by peripheral blood stem cell re-infusion (Day-0) and re-admission on Day +5 in patients with hematological diseases or solid tumors. From 2000 to November 2005, seven patients received tandem Melphalan 200 mg/m(2) HDM with peripheral blood stem cells transplantation (PBSC-T), 130 a single HDM, for a total of 144 procedures. In 123 of them, patients were discharged on Day +1 for re-admission on Day +5 or earlier in the event of complications. Antibiotic prophylaxis was not used. Patients were hospitalised in positive-pressure reverse isolation room during the neutropenic period. Of the 123 procedures eligible for our mixed inpatient-outpatient management regimen, six (5%) required early re-admission for complications. Full engraftment was achieved in all cases. Median time to neutrophil count >0.5 x 10(9)/microL and >1 x 10(9)/microL were 12 and 14 days, respectively. Median time to platelet recovery (>20 x 10(9)/microL) was 13 days. Severe extra-hematological toxicities occurred in 78 (63%) patients: all had oral mucositis and five had associated diarrhoea. During hospitalisation, 94/123 (76%) experienced febrile neutropenia, 20/94 (21%) had documented infection and 74/94 (79%) were considered fever of unknown origin. Median fever duration was 1 day (range 0-11). Median duration of antibiotic treatment was 6 days (range 3-26). Median time to discharge (from Day 0) was 16 days (range 11-57). There was no mortality by on Day +100. Our experience of early discharge after HDM and PBSC-T with re-admission on Day +5 is safe and feasible with acceptable frequency of hematological and extra-hematological toxicities. The regimen allows reduced hospital stay and hence cost savings.
authors.affiliation: Department of Oncology-Hematology, Bone Marrow Unit, Istituto Clinico Humanitas, Rozzano, MI, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Anastasia
authors.forename: Fabio
authors.initials: F
authors.lastname: Giglio
authors.forename: Rita
authors.initials: R
authors.lastname: Mazza
authors.forename: Barbara
authors.initials: B
authors.lastname: Sarina
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Todisco
authors.forename: Stefania
authors.initials: S
authors.lastname: Bramanti
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006402:Hematologic Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D010351:Patient Discharge / Q000191:economics; D036102:Peripheral Blood Stem Cell Transplantation; D013997:Time Factors
chemical_list: D008558:Melphalan