Risk of febrile neutropenia among patients with multiple myeloma or lymphoma who undergo inpatient versus outpatient autologous stem cell transplantation: a systematic review and meta-analysis

Abstract

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.

Hospital and outpatient models for Hematopoietic Stem Cell Transplantation: A systematic review of comparative studies for health outcomes, experience of care and costs

“…To date, most of the high dose therapy and the subsequent supportive care while awaiting hematopoietic recovery have been entirely performed in hospital settings, with a stay of approximately 14 days for autologous HSCT and 30 days for allogeneic HSCT. This can cause a decline in their functional capacity and exposure to nosocomial infections, especially relevant for allogeneic transplant patients when receiving immunosuppression [ 7 , 8 ]. Furthermore, recent studies show that more than half of total charges billed per HSCT correspond to hospital admission costs [ 9 ], with its important effect on health care systems.…”

The influence of high-efficiency particulate air filtration on mortality among multiple myeloma patients receiving autologous stem cell transplantation

“…Furthermore, ambulatory HSCT or even at-home HSCT, emphasizing on outpatient visits only or early discharge after stem cell transfusion, had been demonstrated to be feasible, safe, and cost-effective in several studies, especially for carefully selected MM patients undergoing ASCT 25 – 27 . A meta-analysis even showed a lower chance of febrile neutropenia and septicemia with outpatient ASCT 28 . The necessity of HEPA filtration for MM patients receiving ASCT should be re-examined.…”

The Influence of High-Efficiency Particulate Air Filtration on Mortality Among Multiple Myeloma Patients Receiving Autologous Stem Cell Transplantation: A Nationwide Population-Based Study

“…Furthermore, ambulatory HSCT or even at-home HSCT, emphasizing on outpatient visits only or early discharge after stem cell transfusion, had been demonstrated to be feasible, safe, and cost-effective in several studies, especially for carefully selected MM patients undergoing ASCT [26][27][28] . A meta-analysis even showed a lower chance of febrile neutropenia and septicemia with outpatient ASCT 29 . The necessity of HEPA ltration for MM patients receiving ASCT should be re-examined.…”

“…The median time from MM diagnosis to ASCT was 7.5 (IQR 5.6-10.3) months and 7.0 (IQR 5.3-10.2) months for the HEPA and non-HEPA groups, respectively (p = 0.073). The median length of hospital stay for ASCT was longer for the HEPA group (24)(25)(26)(27)(28)(29) days for the HEPA group and 21 [IQR 18-26] days for the non-HEPA group, p < 0.001). There was no difference in emergency room visits within 14 days (8.3% and 6.4% for HEPA and non-HEPA, respectively) or the readmission rate within 14 days after discharge (6.5% and 4.2% for the HEPA and non-HEPA groups, respectively).…”