Very Low Rate of Readmission after an Early Discharge Outpatient Model for Autografting in Multiple Myeloma Patients: An Italian Multicenter Retrospective Study

Abstract

We analyzed the main modalities and clinical outcomes of the early discharge outpatient model in autologous stem cell transplantation (EDOM-ASCT) for multiple myeloma in Italy. EDOM-ASCT was employed in 382 patients, for a total of 522 procedures, between 1998 and 2012. Our study showed high homogeneity among centers in terms of inclusion criteria, supportive care, and in hospital readmission criteria. Overall, readmissions during the aplastic phase occurred in 98 of 522 transplantations (18.8%). The major extrahematological complication was neutropenic fever in 161 cases (30.8%), which required readmission in 76 cases. The incidence of severe World Health Organization grade 3 to 4 mucositis was 9.6%. By univariate analysis, fever, mucositis, altered renal function at diagnosis, second transplantation, and transplantation performed late in the course of the disease were significantly correlated with readmission, whereas fever, mucositis, altered renal function, and timing of transplantation remained the only independent predictors by multivariate analysis. Overall, transplantation-related mortality was 1.0%. No center effect was observed in this study (P = .36). The safety and low rate of readmission of the EDOM-ASCT in myeloma trial suggest that this strategy could be extended to other transplantation centers if a stringent patient selection and appropriate management are applied.

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

“…9 Our recent national survey in 522 procedures, performed on an outpatient basis, showed an early TRM of 1%. 26 Similar data were reported by Gertz et al 20 and Helbro et al 22 Which is the preferred model for ASCT outpatient management in MM patients?…”

“…In case of fever associated with respiratory distress, oliguria or hemodynamic instability, the patients should be quickly re-hospitalized Abbreviations: ASCT = autologous stem cell transplantation; CVC = central venous catheter; F-U = follow-up; HDM = high-dose melphalan; MM = multiple myeloma; PICC = peripherally inserted central catheter; PS = performance status. a Jagannath et al 14 and Martino et al 26 …”

“…20,22,26 Recent meta-analyses evaluated early TRM in the main randomized studies in MM, which compared ASCT with chemotherapy, and single versus tandem ASCT. TRM was 3%, slightly higher after the second ASCT.…”

“…The panel agreed that differences in ASCT outpatient models and their clinical outcomes in MM might heavily rely on local conditions. However, the panel agreed to recommend the most frequently implemented model reported in the GITMO survey, which is the 'early-discharge outpatient model' (EDOM) that allowed a very low re-admission rate 26 ( Figure 1). Two additional issues that influence outpatient ASCT models are the costeffectiveness and quality of life.…”

“…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.…”