title: Outpatient Autologous Stem Cell Transplantation for Patients With Myeloma.
abstract: BACKGROUND
  High-dose melphalan with autologous stem cell support improves survival for patients with myeloma. For selected patients, we have been using a protocol of short hospitalization, discharging patients to home with careful outpatient monitoring in the office, which we hypothesized would reduce complications and utilization of inpatient beds.
  
  
  METHODS
  We reviewed 301 initial autologous transplants for myeloma, categorized as brief stay (≤ 4 days, 82 patients) or prolonged stay (≥ 5 days, 219 patients). Selection for a brief stay was determined by clinical characteristics, availability of caregivers at home, distance from our medical center, and patient preference.
  
  
  RESULTS
  Within the brief stay population, 67% required readmission before day + 100, but this group still had fewer cumulative hospital days (9 vs. 18, P < .0001). There were fewer documented infections among brief stay patients (22% vs. 46% P < .001) and fewer admissions to intensive care units (0% vs. 5.9%, P = .02). The groups had similar rates of bleeding (1.2% vs. 1.4% P = 1.0) and thrombosis (3.7% vs. 4.6% P = 1.0). No patients in the brief stay group died within 100 days, compared with mortality of 1.8% (P = .6) in the prolonged stay group.
  
  
  CONCLUSIONS
  Carefully selected patients receiving an autologous stem cell transplant for treatment of myeloma can be managed with a brief initial hospitalization and outpatient follow-up, with low morbidity and mortality.
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Paul
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Liu
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Elise A
authors.initials: EA
authors.lastname: Chong
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Selina M
authors.initials: SM
authors.lastname: Luger
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: David L
authors.initials: DL
authors.lastname: Porter
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schuster
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Tsai
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Sunita D
authors.initials: SD
authors.lastname: Nasta
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Alison
authors.initials: A
authors.lastname: Loren
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Noelle
authors.initials: N
authors.lastname: Frey
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Perl
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Cohen
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Weiss
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.affiliation: Hematologic Malignancies and Bone Marrow Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA. Electronic address: dan.vogl@uphs.upenn.edu.
authors.forename: Dan T
authors.initials: DT
authors.lastname: Vogl
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006760:Hospitalization; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000601:surgery*; D010045:Outpatients; D014182:Transplantation, Autologous / Q000379:methods
chemical_list: D008558:Melphalan
keywords: Autologous stem cell transplantation; Clinical research; High-dose melphalan; Multiple myeloma; Outpatient