title: Outpatient administration of BEAM conditioning prior to autologous stem cell transplantation for lymphoma is safe, feasible, and cost-effective.
abstract: High-dose BEAM chemotherapy (BCNU, etoposide, Ara-C, and melphalan) followed by autologous hematopoietic stem cell transplantation is frequently used as consolidative therapy for patients with recurrent or refractory Hodgkin or non-Hodgkin lymphoma. The BEAM regimen has traditionally been administered over 6 days in the hospital, with patients remaining hospitalized until hematologic recovery and clinical stability. In an effort to reduce the length of hospitalization for these patients, our institution has transitioned from inpatient (IP) to outpatient (OP) administration of BEAM conditioning. Here, we report the results of an analysis of the feasibility, cost, complications, and outcomes for the initial group of patients who received OP BEAM compared to a prior cohort of patients who received IP BEAM. Patient and disease characteristics were comparable for the two cohorts, as were engraftment kinetics. Length of hospital stay was reduced by 6 days for the OP cohort (P < 0.001), resulting in a cost savings of more than $17,000 per patient. Fewer complications occurred in the OP cohort, including severe enteritis (P = 0.01), organ toxicities (P = 0.01), and infections (P = 0.04). Overall survival rate up to 3 years posttransplant was better for the OP cohort (P = 0.02), likely due to differences in posttransplant therapies. We conclude that OP administration of BEAM conditioning is safe and may offer significant advantages, including decreased length of hospitalization, reduced costs, decreased risks for severe toxicities and infectious complications, and likely improvement in patient satisfaction and quality of life.
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.|Rochester Regional Health, Rochester, New York.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Reid
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Andrea
authors.initials: A
authors.lastname: Baran
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.|Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Phillips
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Becker
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Lucy
authors.initials: L
authors.lastname: Wedow
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Barr
authors.affiliation: James P Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York.|Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Milner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002330:Carmustine / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007239:Infections / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008223:Lymphoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010045:Outpatients; D011034:Podophyllotoxin / Q000009:adverse effects / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D003561:Cytarabine; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine
keywords: Complications; conditioning chemotherapy; cost; stem cell transplantation