Outpatient myeloablative allo-SCT: a comprehensive approach yields decreased hospital utilization and low TRM.
Historically, myeloablative allogeneic hematopoietic SCT (HSCT) has required prolonged in-patient hospitalization due to the effects of mucosal toxicity and prolonged cytopenias. We explored the safety and feasibility of outpatient management of these patients. A total of 100 consecutive patients underwent a matched-related donor myeloablative allogeneic HSCT for a hematologic malignancy at a single institution. Patients were hospitalized briefly for stem-cell infusion and thereafter only for complications more safely managed in the in-patient setting. The median hospital length of stay from the start of the preparative regimen to day +30 and day +100 post-transplant was 12 and 15 days, respectively. Planned hospital discharge occurred in 79 patients after stem cell infusion. Patients were readmitted to hospital at median of day +7 post transplant, with neutropenic fever being the primary cause for readmission. In total, 18 patients required no in-patient care in the first 100 days. Non-relapse mortality at day 100 and 6 months was 10 and 15%, respectively, for all patients, and 0 and 5%, respectively, for standard risk patients. In summary, outpatient myeloablative allogeneic HSCT with expectant in-patient management can be accomplished safely with low treatment-related morbidity and mortality. Clinical outcomes seem comparable to those reported for traditional in-patient management.
Solomon
S R
SR
Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA 30342, USA. ssolomon@bmtga.com
Matthews
R H
RH
Barreras
A M
AM
Bashey
A
A
Manion
K L
KL
McNatt
K
K
Speckhart
D
D
Connaghan
D G
DG
Morris
L E
LE
Holland
H K
HK
D000328:Adult; D000553:Ambulatory Care; D005260:Female; D006085:Graft Survival; D020544:Graft vs Leukemia Effect; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000209:etiology; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D019172:Transplantation Conditioning; D055815:Young Adult
D019653:Myeloablative Agonists