Outpatient high‐dose melphalan in multiple myeloma patients

Abstract

Ambulatory therapy with HDM is safe and can be achieved in a general outpatient setting. The predictable time to neutropenia allows even poor candidates for outpatient therapy to be admitted electively on Day +4. The apparent beneficial effect of ceftriaxone needs to be confirmed in randomized trials.

Safety and Cost-Effectiveness of Outpatient Autologous Stem Cell Transplantation in Patients with Multiple Myeloma

“…In the study by Kassar et al [4], 73% of patients had DurieSalmon stage III MM, and 16% received 140 mg/m 2 melphalan. More than one-half (58%) of the patients required hospitalization during the follow-up period.…”

“…With better understanding of the disease and improvements in supportive care, initial trials of ASCT in the outpatient setting were conducted [3][4][5]. Outpatient ASCT requires the institution of an interdisciplinary team comprising physicians, nurses, pharmacologists, nutritionists, and social workers [6].…”

Autologous hematopoietic progenitor cell transplantation for multiple myeloma through an outpatient program

“…Studies usually conclude that HDC is feasible and safe in the outpatient setting given the availability of hematopoietic growth factors, myeloablative drugs that do not induce severe mucositis and efficacious antimicrobial prophylaxis, which lowers neutropenia-related complication rates [57]. The easy administration of HDM and the relatively low extra-medullary toxicity, including nausea and vomiting, and the short period of neutropenia [63][64][65] make MM patients ideal candidates for outpatient transplant programs. …”

“…This policy may not negligibly increase the out-of-pocket cost burden to the patients. Using a TOM model, Kassar et al [65] stressed the remarkable consistency in the time to neutropenia (from the HPC infusion day to the day with ANC < 0.5 × 10 9 /L) and its duration in 89 MM patients treated with HDM (140 -200 mg/m 2 ). Nearly two-thirds of patients became neutropenic on day 5 and the remaining developed neutropenia one day earlier or later.…”

Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma

“…7-9 The significant increase in the waiting lists generated concerns about the appropriate use of health care resources and, over the past years, some studies have investigated the safety, efficacy and potential cost advantages of reducing hospital stay for patients undergoing ASCT. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The ease of administering HDM, the relatively low extra-hematological toxicity and the short period of neutropenia 5,6 make MM patients ideal candidates for outpatient ASCT programs. Standardization of criteria for the outpatient ASCT policy is a relevant goal of the Italian hematology and transplant community and may facilitate comparison of retrospective and prospective data.…”