Abstract:High‐dose BEAM chemotherapy (BCNU, etoposide, Ara‐C, and melphalan) followed by autologous hematopoietic stem cell transplantation is frequently used as consolidative therapy for patients with recurrent or refractory Hodgkin or non‐Hodgkin lymphoma. The BEAM regimen has traditionally been administered over 6 days in the hospital, with patients remaining hospitalized until hematologic recovery and clinical stability. In an effort to reduce the length of hospitalization for these patients, our institution has tr… Show more
“…However, our data provide the seeds of rationale for third‐party payers to consider covering costs of housing or providing a monetary incentive for caregiving. This could maximize the utilization of an outpatient transplant program or even support a mixed outpatient/inpatient program, as has been suggested by others …”
Outpatient auto-HCT can be safely performed for selected patients with MM. Differences in outcomes are likely related to baseline clinical characteristics rather than choice of treatment setting.
“…However, our data provide the seeds of rationale for third‐party payers to consider covering costs of housing or providing a monetary incentive for caregiving. This could maximize the utilization of an outpatient transplant program or even support a mixed outpatient/inpatient program, as has been suggested by others …”
Outpatient auto-HCT can be safely performed for selected patients with MM. Differences in outcomes are likely related to baseline clinical characteristics rather than choice of treatment setting.
“…The risk of septicemia was also significantly lower for the outpatients than the inpatients, with a pooled OR of 0.40 (95% CI: 0.16–0.97; p = 0.04; I 2 = 23%; Fig. 3a ) [ 23 , 24 , 28 , 30 ]. However, the risk of C. difficile infection was not significantly different for the two patient groups, with a pooled OR of 0.73 (95% CI: 0.35–1.52; p = 0.40; I 2 = 0%; Fig.…”
Section: Resultsmentioning
confidence: 99%
“…However, the risk of C. difficile infection was not significantly different for the two patient groups, with a pooled OR of 0.73 (95% CI: 0.35–1.52; p = 0.40; I 2 = 0%; Fig. 3b ) [ 26 , 28 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…While the odds of having grade 2–3 mucositis was numerically lower for the outpatient group, the pooled result was not statistically significant (pooled OR 0.65; 95% CI, 0.37–1.15; p = 0.14; I 2 = 4%; Fig. 4a ) [ 23 , 25 , 26 , 28 , 30 ]. Similarly, though the odds ratio of having a TRM appeared to be lower for the outpatient group, it did not achieve statistical significance (pooled OR 0.37; 95% CI, 0.11–1.31; p = 0.12; I 2 = 0%; Fig.…”
BackgroundOutpatient autologous stem cell transplantations (ASCTs) in multiple myeloma and lymphoma patients have been shown to reduce the overall costs and improve the quality of life relative to inpatient ASCTs. This systematic review and meta-analysis was performed with the aim of comprehensively comparing the risk of febrile neutropenia developing in ASCT outpatients and inpatients who have multiple myeloma or lymphoma.MethodsTo be eligible for the meta-analysis, studies needed to be either randomized, controlled studies or cohort studies. They also need to have two groups of patients with multiple myeloma or lymphoma who underwent ASCT, with the treatment being provided to one group in an outpatient setting and to the other on an inpatient basis. The studies had to report our primary outcome of interest, the rate of febrile neutropenia after stem cell infusion, for both groups. The Mantel–Haenszel method was used to pool the effect estimates and 95% confidence intervals of each study.ResultsFrom 9 eligible studies, a total of 1940 patients were included in the meta-analysis. Contrary to conventional concerns, the patients who underwent the outpatient ASCT had a significantly lower risk of developing febrile neutropenia than those admitted for ASCT, with a pooled odds ratio (OR) of 0.44 (95% confidence interval [CI]: 0.29–0.65; p < 0.0001; I2 = 52%). The risk of septicemia was also significantly lower for the outpatients than the inpatients, with a pooled OR of 0.40 (95% CI: 0.16–0.97; p = 0.04; I2 = 23%). Additional analyses found that the odds of having grade 2–3 mucositis and transplant-related mortality were numerically lower for the outpatient group, although the pooled result was not statistically significant. The odds of surviving at 2–3 years was also numerically higher for the ASCT outpatients, but the difference did not reach statistical significance.ConclusionsThis study found a significantly lower odds of developing febrile neutropenia and septicemia among patients with multiple myeloma and lymphoma who received an outpatient ASCT than among those who had an inpatient ASCT.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5054-6) contains supplementary material, which is available to authorized users.
“…The viability, economic impact and safety of the outpatient regimen for high-dose cytarabine consolidation therapy has been previously assessed 1,13,14,15,16,17,18,19 , without significant differences in the incidence of complications 5 . None of these reports, however, were performed in low income regions 20,21 . The benefits of outpatient treatment are even more relevant in developing countries considering costs, access and hospital bed occupancy 22 .…”
Background: The attempt to manage patients with acute myeloid leukemia as outpatients has become increasingly common due to high hospitalization costs, low availability for beds and patient preference. Publications on the subject are scarce, especially in low-income regions and the safety in this population remains to be determined. The present study aims to assess the safety of consolidation with high-dose cytarabine in the outpatient setting.
Materials and Methods: We retrospectively analyzed 39 patients who underwent consolidation with highdose cytarabine, between 2009 and 2018, at Ophir Loyola Hospital, in Belém, Brazil. Patients treated after 2015 were given high-dose cytarabine as outpatients due to the decision of medical staff.
Results: Twenty-seven patients received 76 cycles of cytarabine as outpatients; males were 48.14% of the total population, with a median age of approximately 45 years. The occurrence of delay between cycles was significantly lower among outpatients (48.14% vs. 83.33%, p = 0.04). There was no difference in relapse rates, transfusion requirements and non-relapse mortality between both groups. Hospitalization was required in 40.74% of patients during outpatient cycles and 18.51% of blood cultures were positive for pathogens. Nonrelapse mortality was significantly higher among patients above 50 years old and treated on an outpatient basis (44.4% vs. 5.60%, p = 0.03).
Conclusion: High-dose cytarabine administration on an outpatient basis appears to be safe and effective in a low-income population at the Brazilian Amazon region, but toxicity seems to be increased for patients older than 50 years.
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