Contributions
Abstract: PB2462
Type: Publication Only
Background
Given the improvements in the supportive care, autologous hematopoietic stem cell transplantation (AHSCT) could be performed in outpatient basis, for selected patients (pts), offering the benefit of shorter hospitalization, less exposure to hospital pathogens, saving nosocomial beds, demonstrating thus not only a safe but also a cost effective profile.
Aims
To evaluate the feasibility and safety of the outpatient-basis AHSCT approach
Methods
We retrospectively analyzed outcome of 34 AHSCTs performed on outpatient basis, in a total of 27 pts, previously diagnosed with Hodgkins lymphoma (n= 6) or Multiple Myeloma (n=21); 7 pts with ΜΜ underwent tandem-AHSCT in the context of the scheduled treatment plan. Nine were females and 18 males aged of a median of 48 (25-68) ys. The eligibility criteria for the outpatient AHSCT, were the standard clinical and laboratory tests, plus psychosocial evaluation, patient’s compliance assessment, 24 hours caregiver availability, timely access to the hospital and signed informed consent. The conditioning regimen consisted from single agent Melphalan of 200 (n=25) or 140 mg/m2 (n=9), graft infusion and supportive care were given in an allocated room. The antimicrobial, antifungal and antiviral prophylaxis was administered from day -2 and filgrastim 5 mcg/kg from day +5 till neutrophils recovery. If no infection was documented the antimicrobial and antifungal prophylaxis were discontinued upon stable neutrophils recovery while antiviral prophylaxis was continued for 10-12 months. Patients were evaluated daily or every 2 days in the outpatient clinic. The criteria for admission were fever >38oC, intractable nausea/vomiting or diarrhea, mucositis needing total parenteral nutrition and any other toxicity WHO>grade 3.
Results
The median day for neutrohils >1000/mm3 was 11 (9-18) and for platelets >20000/ mm3 was 11 (0-21); in 2 pts platelets never dropped lower than 25000/mm3. Totally, 15 admissions were required, 10 for inability for food/fluid uptake due to severe mucositis, 4 for febrile neutropenia and 1 for engraftment syndrome. The infections successfully treated with broad spectrum antibiotics and no pt was admitted to intensive care unit. For the whole 34 ASCTs, the total hospitalization days were 77 (median:1, range 0-12) ,while for the 15 admissions the median hospitalization days were 5 (1-12), which favorably compares with the average of 14 hospitalization days for a single “conventional” ASCT. No other toxicities (WHO>3) were observed. Currently 26 / 27 pts are alive 9(1-37) months post AHSCT. Foe pts with MM the 2-years overall and progression free survival are 93% and 65% respectively. All six patients with HL are alive 3-12 months post AHSCT.
Conclusion
Our data indicate that the outpatient-ASCT is a feasible and safe approach provided a caregiver availability, close pts evaluation and adequate supportive care. Keeping in mind the nosocomial complications and the potential high cost of the prolonged hospitalization, it seems that the outpatient ASCT offers lower risk of infections and significant cost saving compared to the “convetional” inpatient ASCT approach.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's Lymphoma, Multiple Myeloma
Abstract: PB2462
Type: Publication Only
Background
Given the improvements in the supportive care, autologous hematopoietic stem cell transplantation (AHSCT) could be performed in outpatient basis, for selected patients (pts), offering the benefit of shorter hospitalization, less exposure to hospital pathogens, saving nosocomial beds, demonstrating thus not only a safe but also a cost effective profile.
Aims
To evaluate the feasibility and safety of the outpatient-basis AHSCT approach
Methods
We retrospectively analyzed outcome of 34 AHSCTs performed on outpatient basis, in a total of 27 pts, previously diagnosed with Hodgkins lymphoma (n= 6) or Multiple Myeloma (n=21); 7 pts with ΜΜ underwent tandem-AHSCT in the context of the scheduled treatment plan. Nine were females and 18 males aged of a median of 48 (25-68) ys. The eligibility criteria for the outpatient AHSCT, were the standard clinical and laboratory tests, plus psychosocial evaluation, patient’s compliance assessment, 24 hours caregiver availability, timely access to the hospital and signed informed consent. The conditioning regimen consisted from single agent Melphalan of 200 (n=25) or 140 mg/m2 (n=9), graft infusion and supportive care were given in an allocated room. The antimicrobial, antifungal and antiviral prophylaxis was administered from day -2 and filgrastim 5 mcg/kg from day +5 till neutrophils recovery. If no infection was documented the antimicrobial and antifungal prophylaxis were discontinued upon stable neutrophils recovery while antiviral prophylaxis was continued for 10-12 months. Patients were evaluated daily or every 2 days in the outpatient clinic. The criteria for admission were fever >38oC, intractable nausea/vomiting or diarrhea, mucositis needing total parenteral nutrition and any other toxicity WHO>grade 3.
Results
The median day for neutrohils >1000/mm3 was 11 (9-18) and for platelets >20000/ mm3 was 11 (0-21); in 2 pts platelets never dropped lower than 25000/mm3. Totally, 15 admissions were required, 10 for inability for food/fluid uptake due to severe mucositis, 4 for febrile neutropenia and 1 for engraftment syndrome. The infections successfully treated with broad spectrum antibiotics and no pt was admitted to intensive care unit. For the whole 34 ASCTs, the total hospitalization days were 77 (median:1, range 0-12) ,while for the 15 admissions the median hospitalization days were 5 (1-12), which favorably compares with the average of 14 hospitalization days for a single “conventional” ASCT. No other toxicities (WHO>3) were observed. Currently 26 / 27 pts are alive 9(1-37) months post AHSCT. Foe pts with MM the 2-years overall and progression free survival are 93% and 65% respectively. All six patients with HL are alive 3-12 months post AHSCT.
Conclusion
Our data indicate that the outpatient-ASCT is a feasible and safe approach provided a caregiver availability, close pts evaluation and adequate supportive care. Keeping in mind the nosocomial complications and the potential high cost of the prolonged hospitalization, it seems that the outpatient ASCT offers lower risk of infections and significant cost saving compared to the “convetional” inpatient ASCT approach.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Hodgkin's Lymphoma, Multiple Myeloma