Feasibility of a mixed inpatient-outpatient model of peripheral blood stem cell transplantation for multiple myeloma

Abstract

BACKGROUND AND OBJECTIVES: A progressively growing number of peripheral blood stem cell transplants (PBSCTs) are being performed in patients with newly diagnosed multiple myeloma (MM) since they are ever more frequently being offered as up-front therapy. Furthermore, there are considerable concerns regarding the appropriate use of health care resources in order to reduce costs associated with PBSCT. One of the strategies attempted to reach this goal is outpatient-based PBSCT. DESIGN AND METHODS: The aim of this study was to analyze the feasibility of a mixed inpatient-outpatient model (MIOM) for MM patients receiving high-dose melphalan, and homogeneously undergoing autologous PBSCT, antimicrobial and antiviral prophylaxis and post-transplant growth factor treatment. Furthermore, we retrospectively compared results of the MIOM with those of the traditional total inpatient model (TIM). RESULTS: MIOM was applied for 60 transplants in a total of 29 MM patients. Results were compared with retrospective data concerning the traditional TIM for 40 transplants (27 MM patients). MIOM cases were older than TIM ones (55.3 6.3 years vs 49.6 9.2 years, p=0.01), but were comparable for sex and disease status. Granulocyte recovery time was shorter in the MIOM group (9.0 0.7 vs 9.7 1.2 days, p=0.004), while a similar number of stem cells were infused. There was no difference in platelet engraftment. The number of episodes and duration of grade II-IV mucositis were similar in both groups. Fever occurred in fewer MIOM cases (25% v 51.6%, p=0.02), while its duration was similar. In multivariate analysis, mucositis (grades II-IV) was the sole independent predictor of fever development (p=0.002). Half of the MIOM cases never required re-admission, 26 were re-admitted (median hospital stay 9 days) and 4 cases were not discharged (median hospital stay 15 days). The median time to discharge of TIM cases was 20 days. Non-hematologic toxicities were low in both groups. INTERPRETATION AND CONCLUSIONS: Since outpatient management and liberal hospitalization criteria have resulted in safe conduct of MIOM transplants, this program can be safely offered to MM patients.