Administering high-dose chemotherapy and autologous stem cell transplant (ASCT) in an outpatient setting was safe and feasible for patients with multiple myeloma, according to the results of a single-center study.
Researchers at Vancouver General Hospital, which has the sole hematopoietic transplant program in British Columbia, Canada, have been conducting outpatient ASCT for patients with plasma cell disorders since 2004.
“Patients with poorer performance status and cardiac amyloidosis are followed more closely and have a lower threshold for hospital admission,” they noted.
They conducted a retrospective study of these procedures performed from 2007 to 2016 to analyze safety and outcomes. During this time, 724 patients underwent 752 ASCTs. The median age of patients was 60. The majority of patients underwent conditioning with melphalan 200 mg/m2.
Patients were recommended for transplant for myeloma (96.9%), amyloidosis (2.4%), and POEMS syndrome (0.7%). Median time from diagnosis to transplant was 5 months.
Approximately one-third of patients required admission to the inpatient ward within the first 30 days after transplant. The median time to this admission was 9 days, and patients were in the inpatient ward for a median of 6 days. The most common causes of hospitalization were febrile neutropenia and mucositis.
However, the overall transplant-related mortality was low at 0.4%. The day 100 all-cause mortality was also low at 0.9%.
“Outpatient ASCTs are safe and result in decreased resource utilization,” the researchers wrote. “Patient selection, appropriate prophylactic antibiotic regimen, a well-equipped and staffed daycare unit to treat infectious complications and administer transfusion blood products, and a multidisciplinary team is essential to deliver this model of care.”
Kodad SG, Sutherland H, Limvorapitak W, et al. Outpatient autologous stem cell transplants for multiple myeloma: analysis of safety and outcomes in a tertiary care center [published online October 8, 2019]. Clin Lymphoma Myeloma Leuk. doi: 10.1016/j.clml.2019.09.619