Outpatient myeloablative allo-SCT: a comprehensive approach yields decreased hospital utilization and low TRM

Bone Marrow Transplant. 2010 Mar;45(3):468-75. doi: 10.1038/bmt.2009.234. Epub 2009 Sep 21.

Abstract

Historically, myeloablative allogeneic hematopoietic SCT (HSCT) has required prolonged in-patient hospitalization due to the effects of mucosal toxicity and prolonged cytopenias. We explored the safety and feasibility of outpatient management of these patients. A total of 100 consecutive patients underwent a matched-related donor myeloablative allogeneic HSCT for a hematologic malignancy at a single institution. Patients were hospitalized briefly for stem-cell infusion and thereafter only for complications more safely managed in the in-patient setting. The median hospital length of stay from the start of the preparative regimen to day +30 and day +100 post-transplant was 12 and 15 days, respectively. Planned hospital discharge occurred in 79 patients after stem cell infusion. Patients were readmitted to hospital at median of day +7 post transplant, with neutropenic fever being the primary cause for readmission. In total, 18 patients required no in-patient care in the first 100 days. Non-relapse mortality at day 100 and 6 months was 10 and 15%, respectively, for all patients, and 0 and 5%, respectively, for standard risk patients. In summary, outpatient myeloablative allogeneic HSCT with expectant in-patient management can be accomplished safely with low treatment-related morbidity and mortality. Clinical outcomes seem comparable to those reported for traditional in-patient management.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Ambulatory Care*
  • Female
  • Graft Survival
  • Graft vs Leukemia Effect
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Hospitalization
  • Humans
  • Infections / etiology
  • Kaplan-Meier Estimate
  • Length of Stay
  • Male
  • Middle Aged
  • Myeloablative Agonists / therapeutic use
  • Transplantation Conditioning
  • Young Adult

Substances

  • Myeloablative Agonists