Abstract
Outpatient hematopoietic stem cell transplants (HSCT) are usually performed in patients receiving minimally mucotoxic preparative regimens; total body irradiation (TBI)-based regimens typically are excluded. To improve resource utilization and patient satisfaction, we developed a totally outpatient HSCT program for TBI regimens and compared outcomes for our first 100 such transplants to 32 performed as in-patients during the same interval, for caregiver or financial reasons. Symptoms were managed predominately with oral agents; pain management consisted of transdermal fentanyl and oral morphine solution. Except for more unmarried in-patients, the two groups were matched. Time to engraftment, severity of mucositis and transplant duration were identical for the two groups. Twenty-seven of the outpatients were admitted (median-6 days), primarily for progressing infection. Thus 92% of all transplant days were outpatient. There were no septic episodes or hospital admissions for pain management. There were no deaths to day 30 in either group and 100-day survival was identical. There was a mean cost savings of $16 000 per outpatient transplant and outpatient patient/caregiver quality of life was similar to that reported for in-patients. Patients undergoing severely mucotoxic regimens can be safely transplanted in an outpatient setting with a significant cost saving, with no increase in morbidity or mortality.
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References
Dix SP, Geller RB . High-dose chemotherapy with autologous stem cell rescue in the outpatient setting. Oncology 2000; 14: 171–185.
Gonzalez-Ryan L, Haut PR, Coyne K, Syckle KV, Duerst R, Haro D et al. Developing a pediatric outpatient transplantation program. The Children's Memorial Hospital experience. Front Biosci 2001; 6: 1–5.
Corcoran-Buchsel P, Parchem C . Ambulatory care of the bone marrow transplant patient. Semin Oncol Nursing 1988; 4: 41–46.
Seropian S, Nadkarni R, Jillella AP, Salloum E, Burtness B, Hu GL et al. Neutropenic infections in 100 patients with non-Hodgkin's lymphoma or Hodgkin's disease treated with high-dose BEAM chemotherapy and peripheral blood progenitor cell transplant: outpatient treatment is a viable option. Bone Marrow Transplant 1999; 23: 599–605.
Meisenberg BR, Ferran K, Hollenbach K, Brehm T, Jollon J, Piro LD . Reduced charges and costs associated with outpatient autologous stem cell transplantation. Bone Marrow Transplant 1998; 21: 927–932.
Coleman EA, Loon SK, Mattox SG, O’Sullivan P . Symptom management and successful outpatient transplantation for patients with multiple myeloma. Cancer Nurs 2002; 25: 452–460.
Ferrara F, Palmieri S, Viola A, Copia C, Schiavone EM, De Simone M et al. Outpatient-based peripheral blood stem cell transplantation for patients with multiple myeloma. Hematol J 2004; 5: 222–225.
Jagannath S, Vesole DH, Zhang M, Desikan KR, Copelan N, Jagannath M et al. Feasibility and cost-effectiveness of out-patient transplants in multiple myeloma. Bone Marrow Transplant 1997; 20: 445–450.
Grimm PM, Zawacki KL, Mock V, Krumm S, Frink BB . Caregiver responses and needs. An ambulatory bone marrow transplant model. Cancer Practice 2000; 8: 120–128.
Stiff PJ, Koester AR, Weidner MK, Dvorak K, Fisher RI . Autologous bone marrow transplantation using unfractionated cells cryopreserved in dimethylsulfoxide and hydroxyethylstarch without controlled-rate freezing. Blood 1987; 70: 974–978.
Derogatis LR, Derogatis MF . Pais & PAIS-SR: Administration, Scoring & Procedures Manual-I. Clinical Psychometric Research: Baltimore, MD, 1990.
Smilkstein G . The family APGAR: a proposal for a family function test and its use by physicians. J Family Practice 1978; 6: 1231–1239.
Montgomery RJV, Gonyea JG, Hooyman NR . Caregiving and the experience of subjective and objective burden. Family Relat 1985; 34: 19–26.
Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.
Bredeson C, Perry G, Martens C, McDiarmid S, Bence-Bruckler I, Atkins H et al. Outpatient total body irradiation as a component of a comprehensive outpatient transplant program. Bone Marrow Transplant 2002; 29: 667–671.
Dagher R, Robertson KA, Lucas KG, Emmanuel D, Smith FO . Outpatient total body irradiation for pediatric patients undergoing stem cell transplantation. Bone Marrow Transplant 1997; 19: 1065–1067.
Hermann RP, Trent M, Cooney J, Cannell PK . Infections in patients managed at home during autologous stem cell transplantation for lymphoma and multiple myeloma. Bone Marrow Transplant 1999; 24: 1213–1217.
Westermann AM, Holtkamp MM, Linthorst GA, van Leeuwen L, Willemese EJ, van Dijk WC et al. At home management of aplastic phase following high-dose chemotherapy with stem-cell rescue for hematological and non-hematological malignancies. Ann Oncol 1999; 10: 511–517.
Siston AK, List MA, Daugherty CK, Banik DM, Menke C, Cornetta K et al. Psychosocial adjustment of patients and caregivers prior to allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 27: 1181–1188.
Foxall MJ, Gaston-Johansson F . Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients. J Advanced Nursing 1996; 24: 915–923.
Rizzo JD, Vogelsang GB, Krumm S, Frink B, Mock V, Bass EB . Out-patient-based bone marrow transplantation for hematologic malignancies: cost saving or cost shifting? J Clin Oncol 1999; 17: 2811–2818.
Selby GB, Ali LI, Carter TH, Veseley S, Roy V . The influence of health insurance on outcomes of related-donor hematopoietic stem cell transplantation for AML and CML. Biol Blood Marrow Transplant 2001; 7: 576.
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Stiff, P., Mumby, P., Miler, L. et al. Autologous hematopoietic stem cell transplants that utilize total body irradiation can safely be carried out entirely on an outpatient basis. Bone Marrow Transplant 38, 757–764 (2006). https://doi.org/10.1038/sj.bmt.1705525
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DOI: https://doi.org/10.1038/sj.bmt.1705525
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