Outpatient total body irradiation prior to bone marrow transplantation in pediatric patients: a feasibility analysis

Applegate, Glenn L.; Mittal, Bharat B.; Kletzel, Morris; Morgan, Elaine; Johnson, Peter; Danner, K.; Marymont, Maryanne Hoffman

doi:10.1038/sj.bmt.1701149

Cited by 7 publications

(5 citation statements)

References 6 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…hydration and the use of 5-hydroxytryptamine receptor antagonist anti-emetics are common features of our program and those that have been previously reported. [2][3][4][5] Along with being well tolerated, outpatient TBI as part of a transplant program was well accepted by patients and care givers. A quality assurance survey regarding the acceptability of outpatient transplants conducted by the OH BMTP in the first 115 patients to participate, indicated that the vast majority of both patients and care givers viewed the experience positively (data not shown).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outpatient total body irradiation as a component of a comprehensive outpatient transplant program

Bredeson

Perry

Martens

et al. 2002

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Outpatient total body irradiation (TBI) as part of a comprehensive outpatient transplant program was delivered to 142 of 167 (85%) consecutive patients receiving TBI-based conditioning therapy. Outpatients received either a single fraction of 500 cGy (110 patients) or 1200 cGy in six fractions over 3 days (32 patients). Patients were assessed daily and were administered oral ondansetron and dexamethasone for prophylaxis of nausea and vomiting as well as i.v. hydration. Accommodation during outpatient TBIbased conditioning was either the patient's home if within 30 min of the hospital, a hotel on the hospital grounds or on a closed hospital ward. None of the 142 patients required admission to the inpatient program during their TBI. There was no difference in 100-day mortality between those receiving TBI as an outpatient (9%) vs as an inpatient (16%). Of four deaths occurring within the first 14 days post transplant, none could be attributed to receiving TBI as an outpatient. Two hundred and six inpatient days were saved through the delivery of outpatient TBI. A comprehensive outpatient program, appropriate patient selection, daily hydration, the use of prophylactic 5HT3 antagonist anti-emetic therapy all contribute to the safe delivery of outpatient TBI. Bone Marrow Transplantation (2002) 29, 667-671. DOI: 10.1038/sj/bmt/1703516 Keywords: outpatient; total body irradiation; stem cell transplantation High-dose therapy and stem cell transplantation is increasingly used in the management of hematological malignancies and other non-malignant disorders. Total body irradiation (TBI)-based regimens are often used as the con-

show abstract

Section: Discussionmentioning

confidence: 99%

“…Initial reports on the feasibility of this approach in select patients were favorable both from the perspective of tolerability and for the potential economic benefits. [2][3][4][5] We report on the Ottawa Hospital Blood and Marrow Transplant Program's (OH BMTP) experience with outpatient TBI delivered as part of a comprehensive outpatient transplant program.…”

mentioning

confidence: 99%

Outpatient total body irradiation as a component of a comprehensive outpatient transplant program

Bredeson

Perry

Martens

et al. 2002

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…However, TBI too is associated with a number of acute side effects that include nausea and vomiting, compounding the side effects of high-dose chemotherapy [4].…”

Section: Introductionmentioning

confidence: 99%

Granisetron in the control of nausea and vomiting associated with bone marrow transplantation: a review of its efficacy and tolerability

Prentice

2003

Supportive Care in Cancer

View full text Add to dashboard Cite

Cancer patients undergoing bone marrow transplantation (BMT) experience severe nausea and vomiting associated with high-dose chemotherapy agents; these emetic symptoms are compounded by total body irradiation used in many conditioning regimens. This paper reviews clinical experience with the 5-HT(3) receptor antagonist granisetron, both as a single agent and in combination with other anti-emetics, in patients undergoing BMT and peripheral blood stem cell transplantation (PBSCT). Clinical studies demonstrate the efficacy (47-61% with no vomiting and no worse than mild nausea) and tolerability of granisetron. Its long half-life and duration of action may be responsible for its effective 24 h control of nausea and vomiting in BMT patients.

show abstract

“…We have taken the approach of dividing outpatient transplantation into partial, where some aspects of the transplant are done in the outpatient setting (i.e. TBI or the post transplant care is provided in the ambulatory setting) and complete where all care is delivered in the outpatient setting (3,4). To date this practice has been primarily used by adult centers with autologous transplantation (5,6).…”

Section: Introductionmentioning

confidence: 99%

Developing a pediatric outpatient transplantation program. The children's memorial hospital experience

et al. 2001

View full text Add to dashboard Cite

We describe the development of a pediatric outpatient transplant program and our initial experience with autologous and allogeneic transplants performed partially or completely in the outpatient setting. Forty-eight autologous and seven allogeneic transplants have been performed in our institution in the outpatient setting between June 1994 and July 2000. The ablation used for the autologous outpatient transplants was VP-16 1000 mg/m2/ day as a continuous infusion for 2 days and Carboplatinum 667mg/m2/day for 2 days. The autologous inpatient transplants received Thio-tepa 300-mg/ m2per day x 3 days and cyclophosphamide 60 mg/kg/day for 4 days. For those patients who received an immune-ablative allogeneic outpatient transplant, the regimen consisted of Fludarabine 30 mg/m2/day for 6 days, followed by busulfan for children less than five years of age 1 mg/kg/dose x 8 doses and for those five years and older 0.8 mg/kg/dose x 8 doses, followed by ATG 40mg/kg/day x 4 days. Engraftment was complete in all transplants achieving an ANC >500 for the outpatient transplant in 15 days (10-35) vs. the inpatient in 15 days (14-58). This was not statistically significant. They achieved un-sustained platelets >20.0 by day 19 (14-58) for the outpatients and day 32 10-64) for the inpatient. The allogeneic immune ablative transplants were considered engrafted when their VNTRs were greater that 30% which was achieved at a median of 13 days (10-27). The economic data showed a statistically significant decrease in charges and direct costs between the outpatient (median charges $30 775, direct costs $8 389) and the inpatient (median charges $99 838, direct costs $42 757) transplants (p0.001). There was no difference in morbidity and mortality between the two groups but the use of empiric amphotericin B was markedly decreased in the outpatient transplants. In conclusion it is feasible and less costly to perform autologous hematopoietic stem cell transplants in the outpatient setting with no increase in morbidity and mortality. For the allogeneic transplants there is not yet enough data to establish a similar conclusion.

show abstract

Outpatient total body irradiation prior to bone marrow transplantation in pediatric patients: a feasibility analysis

Cited by 7 publications

References 6 publications

Outpatient total body irradiation as a component of a comprehensive outpatient transplant program

Outpatient total body irradiation as a component of a comprehensive outpatient transplant program

Granisetron in the control of nausea and vomiting associated with bone marrow transplantation: a review of its efficacy and tolerability

Developing a pediatric outpatient transplantation program. The children's memorial hospital experience

Contact Info

Product

Resources

About