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Supportive Care

Safety of outpatient autologous hematopoietic cell transplantation for multiple myeloma and lymphoma

Bone Marrow Transplantation volume 50, pages 947–953 (2015)Cite this article

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Abstract

Autologous hematopoietic cell transplantation (Auto-HCT) is commonly an in-patient procedure. However, Auto-HCT is increasingly being offered on an outpatient basis. To better characterize the safety of outpatient Auto-HCT, we compared the outcome of 230 patients who underwent Auto-HCT on an in-patient vs outpatient basis for myeloma or lymphoma within a single transplant program. All outpatient transplants occurred in a cancer center day hospital. Hematopoietic recovery occurred earlier in the outpatient cohort, with median time to neutrophil recovery of 10 vs 11 days (P<0.001) and median time to platelet recovery of 19 vs 20 days (P=0.053). Fifty-one percent of the outpatient cohort never required admission, with this percentage increasing in later years. Grade 3–4 non-hematologic toxicities occurred in 29% of both cohorts. Non-relapse mortality at 1 year was 0% in the outpatient cohort and 1.5% in the in-patient cohort (P=0.327). Two-year PFS was 62% for outpatient vs 54% for in-patient (P=0.155). One- and two-year OS was 97% and 83% for outpatient vs 91% and 80% for in-patient, respectively (P=0.271). We conclude that, with daily outpatient evaluation and aggressive supportive care, outpatient Auto-HCT can result in excellent outcomes for myeloma and lymphoma patients.

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Acknowledgements

We thank the nursing staff, physician assistants, nurse practitioners, medical residents and hematology/oncology fellows who helped care for these patients on both the in-patient and outpatient transplant units, Jean Esselmann for transplant coordination and Charles Zhao for database support.

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Author notes

  1. T M Graff and A K Singavi: These authors contributed equally to this work.

Authors and Affiliations

  1. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    T M Graff, W Schmidt, W R Drobyski, M Horowitz, M Pasquini, D J Rizzo, W Saber, P Hari & T S Fenske

  2. Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    A K Singavi

  3. Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA

    D Eastwood

  4. Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA

    J Palmer

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  1. T M Graff
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  2. A K Singavi
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  3. W Schmidt
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  4. D Eastwood
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Correspondence to T S Fenske.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Graff, T., Singavi, A., Schmidt, W. et al. Safety of outpatient autologous hematopoietic cell transplantation for multiple myeloma and lymphoma. Bone Marrow Transplant 50, 947–953 (2015). https://doi.org/10.1038/bmt.2015.46

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