Outpatient stem cell transplantation for multiple myeloma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 43; no. S1; p. S146
• Main Authors: Ghavamzadeh, A, Alimoghaddam, K, Karimi, A, Manookian, A, Asadi, M, Maheri, R, Shamshiri, A.R
• Format: Journal Article
• Language: English
• Published: Nature Publishing Group 01-03-2009
• Subjects: Care and treatment; Dosage and administration; Melphalan; Multiple myeloma; Patient outcomes; Stem cells; Transplantation; Iran
• ISSN: 0268-3369

Introduction: The aim of this study was to explore the feasibility and safety of performing aoutologous stem cell transplantation (ASCT) on an outpatient basis. Methods: Total of 134 patients affected by multiple myeloma (MM) in complete remission (CR) or partial remission (PR) were selected to receive ASCT on an outpatient or inpatient basis. Our analysis consist of 100 patients. Median age was 50.2 years (ranged 27-68) with 70% male. In the inpatient group 34 patients received 200 mg/[m.sup.2] and 21 patients received 140 mg/[m.sup.2] melphalan as conditioning regimen respectively. In outpatient group 13 patients received 140 mg/[m.sup.2] and 32 patients received 200 mg/[m.sup.2] melphalan. In outpatient group all the patients were programmed to go home the day after ASCT and to be re-hospitalized in the case of febrile neutropenia or other sever toxicities. We used caregiver, general physician, staff nurse as an outpatient and visit team and also unequipped routine house of the patients during neutropenia. Results: Median hospital stay were 25 days in inpatient and. 4.8 days in outpatient respectively (p<0.01). There were not significant differences between these groups in aphresis days, granulocyte colony stimulating factor requirement for mobilization and mononuclear cell, There were also significant reduction (p<0.001) in parenteral antibiotic, blood product requirement and need for total parenteral nutrition. The most frequent causes of re-admission in 6 patients (outpatient group) were febrile neutropenia and sever mucositis need TPN. 2 years overall survival rate was 98.2% (SE=2%) in inpatient groups and 86.6% (SE=5.7) in outpatient groups. Conclusion: The ease of administration of high dose melphalan as well as the lack of excessive extramedullary toxicity including nausea and vomiting renders patients with MM more suitable for outpatient management, in the present study, we describe an outpatient program based on management of the patient in his/her house during aplastic phase. Our results clearly indicate that such a procedure is feasible and safe in a patient population with an assessable caregiver.