Management of early period of hematopoietic cell transplantation in ambulatory/outpatient setting with primary antimicrobial prophylaxis: an attractive option
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Abstract
The concept of ambulatory/outpatient transplantations is based on variable distribution and location of performing basic stages of hematopoietic cell transplantation (HCT): central venous catheter insertion, high-dose chemotherapy administration, hematopoietic stem cells infusion, and supportive care during aplastic phase.
Our objective was to present the concept of outpatient transplantation and to review the available data on prophylaxis of infectious complications early after outpatient transplantation.
In our general recommendations, patients, family members and caregivers should be trained before discharge on the careful monitoring of fever and other signs and symptoms of infections. The clinical evaluation of patients should be performed twice weekly until clinical recovery. Standard transplant approach should be applied for dose of CD34+ cells, use of granulocyte colony-stimulating factor after HSC infusion, use of primary antimicrobial prophylaxis, and supportive care. Antimicrobial prophylaxis for ambulatory auto-HCT patients should be the same as for a conventional inpatient setting, including antibacterial, antiviral and anti-Pneumocystis jiroveci pneumonia (PjP) prophylaxis. For patients undergoing allo-HCT in an outpatient setting, the general recommendations are the same as for auto-HCT patients. Frequent monitoring of immunosuppressive treatment is recommended. Monitoring for cytomegalovirus infection and Aspergillus galactomannan should be the same as for conventional allo-HCT. Primary anti-mold prophylaxis is strongly suggested.
Ambulatory auto-HCT is feasible and safe, making this an important alternative option. This is an especially attractive option for multiple myeloma patients, as it has a very low transplant-related mortality risk. Obviously, ambulatory auto-HCT cannot be regarded as a routine procedure.
Keywords: hematopoietic cell transplantationoutpatient transplantationinfectious complicationsprophylaxis
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