Multiple Myeloma Outpatient Transplant Program in the Era of Novel Agents: State-of-the-Art

Abstract

Multiple myeloma (MM) is the most common indication for autologous stem cell transplantation (ASCT), and outpatient models have been widely developed in this setting. Although numerous studies have demonstrated the safety and feasibility of outpatient ASCT, it is not a routine procedure. Stringent guidelines for patient selection and clinical management, including functional status, caregiver support, and psychological aspects, are essential to identify eligible patients. However, there is still no general agreement on these criteria. Quality of life data are limited and contradictory. There is considerable variability in outpatient transplant models, and there are no randomised studies supporting the use of one over the other. Studies evaluating results in terms of long-term survival, transplant toxicity in comparison with a standard approach are lacking. The procedure is cost-effective within the context of a hospital budget, but an in-depth analysis of the real cost of these programmes has yet to be performed.

Digital Health for Patients With Multiple Myeloma: An Unmet Need

“…Among patients with MM who received an ASCT, readmission rates can occur in as many as 86% of patients, with fever being one of the predictive factors for readmission. 69,70 Accordingly, a passive sensor like the VitalPatch or a similar wearable device that monitors temperature will play an important role in the post-transplant setting. Medication adherence is an important priority for patients being treated with oral therapies, and this issue will perhaps require the most personalization of digital and mobile tools.…”

Management of early period of hematopoietic cell transplantation in ambulatory/outpatient setting with primary antimicrobial prophylaxis: an attractive option

“…The main clinical indications for outpatient auto-HCT are multiple myeloma (after conditioning with melfalan) and lymphoma [both non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL, mainly after conditioning BEAM {carmustine, etoposide, cytarabine, mel-phalan}/BEAC {carmustine, etoposide, cytosine arabinoside, cyclophosphamide})], while rarely for other indications. Typical inclusion criteria include a high educational status and overall good clinical condition of the patient (Table II) [2,3]. It is important that the distance from the patient's house to the hospital can be covered within one hour.…”

“…Patients, family members and caregivers should be trained before discharge on the careful monitoring of fever and other signs and symptoms of infections. The first clinical evaluation of a patient should be performed no later than day +5 after discharge, and then repeated twice weekly until sustained hematological engraftment and clinical recovery [3].…”

“…Antimicrobial prophylaxis for ambulatory auto-HCT patients should be the same as for a conventional inpatient setting [14,15], including antibacterial prophylaxis with quinolones, antiviral prophylaxis with acyclovir (at least up to three months after transplantation) and prophylaxis against Pneumocystis jiroveci with cotrimoxazole; primary antifungal prophylaxis is generally not recommended [3]. Real world data regarding infectious prophylaxis in outpatient auto-HCT studies has been summarized elsewhere [12].…”

“…outpatient settings (Table I) [2,3]. Regardless of the inpatient/outpatient setting, the transplant itself carries the risk of typical transplant-related complications, namely toxicity and infections, and, in the case of allogeneic HCT, graft-versus-host disease (GvHD).…”