open access

Vol 52, No 3 (2021)
Review article
Submitted: 2021-03-15
Accepted: 2021-04-05
Published online: 2021-06-28
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Management of early period of hematopoietic cell transplantation in ambulatory/outpatient setting with primary antimicrobial prophylaxis: an attractive option

Jan Styczyński1, Agata Marjańska1
DOI: 10.5603/AHP.2021.0034
·
Acta Haematol Pol 2021;52(3):173-177.
Affiliations
  1. Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jurasz University Hospital 1, Bydgoszcz, Poland

open access

Vol 52, No 3 (2021)
REVIEW ARTICLE
Submitted: 2021-03-15
Accepted: 2021-04-05
Published online: 2021-06-28

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.

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.

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Keywords

hematopoietic cell transplantation, outpatient transplantation, infectious complications, prophylaxis

About this article
Title

Management of early period of hematopoietic cell transplantation in ambulatory/outpatient setting with primary antimicrobial prophylaxis: an attractive option

Journal

Acta Haematologica Polonica

Issue

Vol 52, No 3 (2021)

Article type

Review article

Pages

173-177

Published online

2021-06-28

DOI

10.5603/AHP.2021.0034

Bibliographic record

Acta Haematol Pol 2021;52(3):173-177.

Keywords

hematopoietic cell transplantation
outpatient transplantation
infectious complications
prophylaxis

Authors

Jan Styczyński
Agata Marjańska

References (21)
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