OUTPATIENT-BASED AUTOLOGOUS STEM CELL TRANSPLANTATION: FEASIBLE, SAFE AND COST EFFECTIVE APPROACH Hani Al Hashmi, Panayotis Kaloyannidis, Eshrak Al Shibani, Nihad Mokhtar, Solaf Kafnar, Khalid Bakhit, Ann Estanislao, Fuad Abdulrahma, Reem Khalili, John Apostolidis, Khalid Al Anezi King Fahad Specialist Hospital, Adult Hematology and Stem Cell Transplantation Department, Dammam, Saudi Arabia Background Methods Criteria for admission Fever >38oC Intractable vomiting/nausea, diarrhea Severe mucositis Need for parenteral nutrition Any toxicity >WHO gr3 Given the current improvements in the supportive care during the peri-transplant period, autologous stem cell transplantation (ASCHT) became feasible in outpatient basis, especially if the conditioning regimen dose not require continuous long term infusion, offering thus benefits in terms of: Shorter hospitalization period Minimal exposure to hospital pathogens Cost effectiveness Result Engraftment Days of ANC >1000/mm3 +11(11-18) Days of Platelets >25000/mm3 +11(0-21) Severe toxcity (grade ≥3) 0 Admissions Total admissions 14/31 (45%) Total hospitalization days 65 Median hospitalization days 1(0-9) Reason for admission Fever + severe mucositis 4 Mucositis gr3/ poor oral intake 9 Engraftment syndrome 1 Survival All patients are alive for a median of 9 (1-36) months post AHSCT Aim To evaluate the Feasibility Safety. In out patient-basis ASCHT Methods Eligibility criteria for out patient basis auto-transplants Standard clinical and laboratory tests Psychosocial evaluation Patient’s compliance assessment 24-hours caregiver availability Timely access to the hospital Signed informed consent Patients-transplants Number pf patients 24 Number of transplants 31 Gender (M/F) 16/8 Age (med) yrs 51 (25-68) Diagnosis Multiple myeloma 18 Relapse/Refractory Hodgkin Lymphoma 6 Conclusion/ comments The outpatient-ASCT is a feasible and safe approach provided that there is: Available caregiver Closely evaluation Adequate supportive care Considering that a “conventional –ASCT” requires usually 15 hospitalization days in average, it is obvious the total of 65 hospitalization days for 31 outpatient–ASCTs , is favorable comparable with the expected total of 31x15= 465 hospitalization–days for the in patient-ASCT approach. According to our results it seems that the out patient- ASCT offers: Less hospitalization days (approximately 400 days) lower risk of infection. Saving significant inpatients beds Decrease waiting time for bed availability. Significant cost saving. Conditioning regimen Melphalan 200mg/m2 (N=23) Melphalan 140mg/m2 (N=8) Graft infusion was given in an allocated room Supportive care Agent From Antibacterial Antifungal Day -2 Antiviral Filgrastim 5mg/kg Day+5 till ANCs recovery Patients were evaluated daily or every other day in the outpatient clinic