Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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

Subjects

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.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

References

  1. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-hodgkin's lymphoma. N Engl J Med 1995; 333: 1540–1545.

    Article  CAS  Google Scholar 

  2. Geisler CH . Autologous transplantation and management of younger patients with mantle cell lymphoma. Best Pract Res Clin Haematol 2012; 25: 211–220.

    Article  Google Scholar 

  3. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive hodgkin's disease: a randomised trial. Lancet 2002; 359: 2065–2071.

    Article  CAS  Google Scholar 

  4. Schouten HC, Qian W, Kvaloy S, Porcellini A, Hagberg H, Johnsen HE et al. High-dose therapy improves progression-free survival and survival in relapsed follicular non-hodgkin's lymphoma: results from the randomized european CUP trial. J Clin Oncol 2003; 21: 3918–3927.

    Article  CAS  Google Scholar 

  5. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  Google Scholar 

  6. Attal M, Harousseau J, Stoppa A, Sotto J, Fuzibet J, Rossi J et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. N Engl J Med 1996; 335: 91–97.

    Article  CAS  Google Scholar 

  7. Leger C, Sabloff M, McDiarmid S, Bence-Bruckler I, Atkins H, Bredeson C et al. Outpatient autologous hematopoietic stem cell transplantation for patients with relapsed follicular lymphoma. Ann Hematol 2006; 85: 723–729.

    Article  Google Scholar 

  8. Frey P, Stinson T, Siston A, Knight SJ, Ferdman E, Traynor A et al. Lack of caregivers limits use of outpatient hematopoietic stem cell transplant program. Bone Marrow Transplant 2002; 30: 741–748.

    Article  CAS  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. Gluck S, des Rochers C, Cano C, Dorreen M, Germond C, Gill K et al. High-dose chemotherapy followed by autologous blood cell transplantation: A safe and effective outpatient approach. Bone Marrow Transplant 1997; 20: 431–434.

    Article  CAS  Google Scholar 

  11. McDiarmid S, Hutton B, Atkins H, Bence-Bruckler I, Bredeson C, Sabri E et al. Performing allogeneic and autologous hematopoietic SCT in the outpatient setting: effects on infectious complications and early transplant outcomes. Bone Marrow Transplant 2010; 45: 1220–1226.

    Article  CAS  Google Scholar 

  12. Schulmeister L, Quiett K, Mayer K . Quality of life, quality of care, and patient satisfaction: perceptions of patients undergoing outpatient autologous stem cell transplantation. Oncol Nurs Forum 2005; 32: 57–67.

    Article  Google Scholar 

  13. Kim JH, Goulston C, Zangari M, Tricot G, Boyer MW, Hanson KE . Impact of a change in antibacterial prophylaxis on bacteremia and hospitalization rates following outpatient autologous peripheral blood stem cell transplantation for multiple myeloma. Transpl Infect Dis 2014; 16: 421–429.

    Article  CAS  Google Scholar 

  14. Jagannath S, Vesole DH, Zhang M, Desikan KR, Copeland N, Jagannath M et al. Feasibility and cost-effectiveness of outpatient autotransplants in multiple myeloma. Bone Marrow Transplant 1997; 20: 445–450.

    Article  CAS  Google Scholar 

  15. Ferrara F, Izzo T, Criscuolo C, Riccardi C, Viola A, Delia R et al. Comparison of fixed dose pegfilgrastim and daily filgrastim after autologous stem cell transplantation in patients with multiple myeloma autografted on a outpatient basis. Hematol Oncol 2011; 29: 139–143.

    Article  CAS  Google Scholar 

  16. 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: 222–226.

    Article  Google Scholar 

  17. Meisenberg BR, Miller WE, McMillan R, Callaghan M, Sloan C, Brehm T et al. Outpatient high-dose chemotherapy with autologous stem-cell rescue for hematologic and nonhematologic malignancies. J Clin Oncol. 1997; 15: 11–17.

    Article  CAS  Google Scholar 

  18. Freeman B, Brauneis D, Seldin DC, Quillen K, Sloan JM, Renteria AS et al. Hospital admissions following outpatient administration of high-dose melphalan and autologous SCT for AL amyloidosis. Bone Marrow Transplant 2014; 49: 1345–1346.

    Article  CAS  Google Scholar 

  19. Holbro A, Ahmad I, Cohen S, Roy J, Lachance S, Chagnon M et al. Safety and cost-effectiveness of outpatient autologous stem cell transplantation in patients with multiple myeloma. Biol Blood Marrow Transplant 2013; 19: 547–551.

    Article  Google Scholar 

  20. Rizzo JD, Vogelsang GB, Krumm S, Frink B, Mock V, Bass EB . Outpatient-based bone marrow transplantation for hematologic malignancies: cost saving or cost shifting? J Clin Oncol 1999; 17: 2811–2818.

    Article  CAS  Google Scholar 

  21. McDonald JC, Stetz KM, Compton K . Educational interventions for family caregivers during marrow transplantation. Oncol Nurs Forum 1996; 23: 1432–1439.

    CAS  PubMed  Google Scholar 

Download references

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.

Author information

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

Authors
  1. T M Graff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A K Singavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Eastwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W R Drobyski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M Horowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M Pasquini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D J Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. W Saber
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P Hari
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. T S Fenske
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T S Fenske.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2015.46

This article is cited by

Search

Advanced search

Quick links