1. 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/mm (11-18)
Days of Platelets >25000/mm (0-21)
Severe toxcity (grade ≥3)
Admissions
Total admissions /31 (45%)
Total hospitalization days
Median hospitalization days (0-9)
Reason for admission
Fever + severe mucositis
Mucositis gr3/ poor oral intake
Engraftment syndrome
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
Number of transplants
Gender (M/F) /8
Age (med) yrs (25-68)
Diagnosis
Multiple myeloma
Relapse/Refractory Hodgkin Lymphoma
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