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Hospital admissions following outpatient administration of high-dose melphalan and autologous SCT for AL amyloidosis

Bone Marrow Transplantation volume 49, pages 1345–1346 (2014)Cite this article

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The use of intensive clinic support to permit outpatient high-dose chemotherapy with autologous SCT (HDC/SCT) has been described in the literature for two decades. This approach has the theoretical advantages of reducing cost and also reducing the incidence of iatrogenic infections acquired in the hospital environment. In one of the first reports using this approach, Peters et al.1 found that ~70% of 92 breast cancer patients treated with HDC/SCT as outpatients required either no hospital admission or brief admissions of 1–4 days, resulting in a 50% reduction in cost compared to the traditional inpatient approach. Prophylactic antibiotics facilitate the outpatient management of myelosuppressed patients treated with HDC/SCT, although in one study 26% of patients were readmitted to the hospital for fever or infection despite treament with prophylactic ciprofloxacin and rifampin.2 In that study, 62% of the patients developed febrile neutropenia following HDC/SCT, but in most cases this was managed with empiric antibiotics as an outpatient; there was one death (0.7%) from invasive aspergillosis. Interestingly, Fernandez-Aviles et al.3 developed an ‘at-home’ program for patients with hematologic malignancies undergoing HDC/SCT that utilized prophylactic ceftriaxone and treatment of febrile neutropenia with pipercillin-tazobactam. Compared with a control group of individually matched patients treated with conventional hospital-based care, this intervention resulted in a lower rate (76 vs 96%) and shorter duration (median 2 vs 6 days) of febrile neutropenia, a hospital readmission rate of only 8%, a reduction of 19 days of hospitalization per patient, and a cost savings of ~50%.

Our institutional experience is unusual in that the majority of patients undergoing HDC/SCT have AL amyloidosis and are treated with a high-dose melphalan conditioning regimen. All phases of treatment, including stem cell mobilization, stem cell collection, administration of high-dose melphalan and stem cell infusion and post-SCT management, are performed in the outpatient clinic.4

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References

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Authors and Affiliations

  1. Stem Cell Transplantation Program, Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA

    B Freeman, D Brauneis, D C Seldin, K Quillen, J M Sloan, A S Renteria, A C Shelton, T Teschner, K T Finn & V Sanchorawala

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  1. B Freeman
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  2. D Brauneis
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  3. D C Seldin
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  4. K Quillen
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  5. J M Sloan
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  6. A S Renteria
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  7. A C Shelton
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  8. T Teschner
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  9. K T Finn
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  10. V Sanchorawala
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Correspondence to V Sanchorawala.

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Freeman, B., Brauneis, D., Seldin, D. et al. Hospital admissions following outpatient administration of high-dose melphalan and autologous SCT for AL amyloidosis. Bone Marrow Transplant 49, 1345–1346 (2014). https://doi.org/10.1038/bmt.2014.132

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