Very low rate of readmission after an early discharge outpatient model for autografting in multiple myeloma patients: an Italian multicenter retrospective study.
We analyzed the main modalities and clinical outcomes of the early discharge outpatient model in autologous stem cell transplantation (EDOM-ASCT) for multiple myeloma in Italy. EDOM-ASCT was employed in 382 patients, for a total of 522 procedures, between 1998 and 2012. Our study showed high homogeneity among centers in terms of inclusion criteria, supportive care, and in hospital readmission criteria. Overall, readmissions during the aplastic phase occurred in 98 of 522 transplantations (18.8%). The major extrahematological complication was neutropenic fever in 161 cases (30.8%), which required readmission in 76 cases. The incidence of severe World Health Organization grade 3 to 4 mucositis was 9.6%. By univariate analysis, fever, mucositis, altered renal function at diagnosis, second transplantation, and transplantation performed late in the course of the disease were significantly correlated with readmission, whereas fever, mucositis, altered renal function, and timing of transplantation remained the only independent predictors by multivariate analysis. Overall, transplantation-related mortality was 1.0%. No center effect was observed in this study (P = .36). The safety and low rate of readmission of the EDOM-ASCT in myeloma trial suggest that this strategy could be extended to other transplantation centers if a stringent patient selection and appropriate management are applied.
Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera BMM, Reggio Calabria, Italy. Electronic address: dr.massimomartino@gmail.com.
Massimo
M
Martino
Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
Mauro
M
Montanari
Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera A. Cardarelli, Napoli, Italy.
Felicetto
F
Ferrara
Ematologia con Trapianto di Midollo Osseo IRCCS Ospedale San Raffaele, Milano, Italy.
Fabio
F
Ciceri
Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
Ilaria
I
Scortechini
Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera A. Cardarelli, Napoli, Italy.
Salvatore
S
Palmieri
Ematologia con Trapianto di Midollo Osseo IRCCS Ospedale San Raffaele, Milano, Italy.
Sarah
S
Marktel
Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera San Carlo, Potenza, Italy.
Michele
M
Cimminiello
Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
Giuseppe
G
Messina
Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
Giuseppe
G
Irrera
Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
Massimo
M
Offidani
Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
Giuseppe
G
Console
Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano (MI), Italy.
Luca
L
Castagna
Unità Trapianto di Midollo Osseo, Dipartimento di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy.
Giuseppe
G
Milone
Divisione Universitaria di Ematologia, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy.
Benedetto
B
Bruno
Consiglio Nazionale delle Ricerche, Istituto di Biomedicina ed Immunologia Molecolare, Reggio Calabria, Italy.
Giovanni
G
Tripepi
Cattedra di Ematologia, Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy.
Roberto Massimo
RM
Lemoli
Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
Attilio
A
Olivieri
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000453:epidemiology / Q000628:therapy*; D010045:Outpatients; D010359:Patient Readmission; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D014182:Transplantation, Autologous
Autologous stem cell transplantation; Early discharge model; Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO) survey; Multiple myeloma; Outpatient