title: Outpatient myeloablative allo-SCT: a comprehensive approach yields decreased hospital utilization and low TRM.
abstract: 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.
authors.affiliation: Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA 30342, USA. ssolomon@bmtga.com
authors.forename: S R
authors.initials: SR
authors.lastname: Solomon
authors.forename: R H
authors.initials: RH
authors.lastname: Matthews
authors.forename: A M
authors.initials: AM
authors.lastname: Barreras
authors.forename: A
authors.initials: A
authors.lastname: Bashey
authors.forename: K L
authors.initials: KL
authors.lastname: Manion
authors.forename: K
authors.initials: K
authors.lastname: McNatt
authors.forename: D
authors.initials: D
authors.lastname: Speckhart
authors.forename: D G
authors.initials: DG
authors.lastname: Connaghan
authors.forename: L E
authors.initials: LE
authors.lastname: Morris
authors.forename: H K
authors.initials: HK
authors.lastname: Holland
mesh_terms: 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
chemical_list: D019653:Myeloablative Agonists