Safety and cost effectiveness of outpatient autologous hematopoietic stem cell transplantation for multiple myeloma — single-center experience of a pilot Early Discharge Program
, 1, 1, 1, 1, 1
Abstract
Introduction: Multiple myeloma (MM) is the leading indication for autologous stem cell transplantation (ASCT), with over 12,000 transplants per year in Europe. Due to low toxicity, an entirely outpatient procedure or an early discharge after ASCT can be considered as alternatives to inpatient transplantation. Thus, we launched an Early Discharge Program (EDP) for patients qualified for ASCT due to MM who were under 60 years of age, without significant comorbidities, who had a caregiver available 24/7, and who lived within a 60-minute drive of our hospital.
Material and methods: Patients spent 72 hours in the hospital being administered melphalan 200 mg/m2 intravenous followed by an infusion of hematopoietic stem cells. They were eventually discharged and remained under outpatient care. The program was launched in September 2019 and was temporarily halted due to the coronavirus disease 19 (COVID-19) pandemic in early 2020. Five patients were enrolled to the EDP.
Results: Non-hematological toxicity was mild and manageable in an outpatient setting. Only one patient was readmitted due to exacerbation of ulcerative colitis that was probably not related to ASCT. We observed neither infections nor bleeding. Due to hematological toxicity, three of the five patients received platelet transfusion on the 6th day after ASCT as outpatients. No packed erythrocytes were transfused. The EDP demonstrated lower costs compared to an inpatient approach.
Conclusions: We believe that early discharge, which is an intermediate step to full at-home transplantation due to patients’ wellbeing, reduction of infections caused by resistant microorganisms, and costs, will eventually replace a full inpatient procedure for a significant population of patients suffering from multiple myeloma and indeed other diseases.
Keywords: multiple myelomatransplantationat-home transplantation
References
- Palumbo A, Cavallo F, Gay F, et al. Autologous transplantation and maintenance therapy in multiple myeloma. N Engl J Med. 2014; 371(10): 895–905.
- Cavo M, Rajkumar SV, Palumbo A, et al. International Myeloma Working Group. International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood. 2011; 117(23): 6063–6073.
- Passweg JR, Baldomero H, Chabannon C, et al. European Society for Blood and Marrow Transplantation (EBMT). The EBMT activity survey on hematopoietic-cell transplantation and cellular therapy 2018: CAR-T's come into focus. Bone Marrow Transplant. 2020; 55(8): 1604–1613.
- Fernández-Avilés F, Carreras E, Urbano-Ispizua A, et al. Case-control comparison of at-home to total hospital care for autologous stem-cell transplantation for hematologic malignancies. J Clin Oncol. 2006; 24(30): 4855–4861.
- Anastasia A, Giglio F, Mazza R, et al. Early discharge after high-dose melphalan and peripheral blood stem cell reinfusion in patients with hematological and non-hematological disease. Leuk Lymphoma. 2009; 50(1): 80–84.
- Carreras E, Dufour C, Mohty M, Kröger N. EBMT hanboook: hematopoietic stem cell transplantation and cellular therapies. Springer, Cham 2019.
- Giannopoulos K, Jamroziak K, Usnarska-Zubkiewicz L, et al. Zalecenia Polskiej Grupy Szpiczakowej dotyczące rozpoznawania i leczenia szpiczaka plazmocytowego oraz innych dyskrazji plazmocytowych na rok 2018/2019. Acta Haematologica Polonica. 2018; 49(4): 157–206.
- Szpiczak plazmocytowy (mnogi). Ocena jakości informacyjnej rejestru kontraktowego. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjYjMeF7aDwAhVsgv0HHZ56Ak4QFjAAegQIAhAD&url=https%3A%2F%2Fezdrowie.gov.pl%2Fpobierz%2F191231_szpiczak_plazmocytowy&usg=AOvVaw208uLqcF5mVKVOqKAMPLI1 (January 23, 2021).
- Holbro A, Ahmad I, Cohen S, et al. Safety and cost-effectiveness of outpatient autologous stem cell transplantation in patients with multiple myeloma. Biol Blood Marrow Transplant. 2013; 19(4): 547–551.
- Martino M, Lemoli RM, Girmenia C, et al. Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma. Bone Marrow Transplant. 2016; 51(8): 1032–1040.
- Faucher C, Le Corroller Soriano AG, Esterni B, et al. Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs. Bone Marrow Transplant. 2012; 47(4): 549–555.
- Summers N, Dawe U, Stewart DA. A comparison of inpatient and outpatient ASCT. Bone Marrow Transplant. 2000; 26(4): 389–395.
- Martino M, Paviglianiti A, Memoli M, et al. Multiple myeloma outpatient transplant program in the era of novel agents: state-of-the-art. Front Oncol. 2020; 10: 592487.
