International Journal of Hematology-Oncology and Stem Cell Research 2009. 3(3):4-7.

A Preliminary Report on the Feasibility of Outpatient Autologous Stem Cell Transplantation in Iran
Ardeshir Ghavamzadeh, Abolghasem Allahyari, Kamran Alimoghaddam, M Esfandbod, M Malekpour, Akram Karimi, Arpi Manokian, M Asadian, Farnaz Khatami

Abstract


Introduction: Autologous stem cells have greatly influenced the treatment of a variety of malignancies including Hodgkin/non-Hodgkins lymphoma and acute leukemias. This is a preliminary study comparing the time of engraftment, mortality rate and cost of treatment in outpatient versus inpatient autologous stem cell transplantation (SCT) in Iran.
Patients and Methods: 11 outpatients (6 Hodgkin Lymphoma (HL), 3 Non-Hodgkin Lymphoma (NHL) and 2 Acute Myeloid Leukemia (AML)) were compared with 32 inpatients (15 HL, 8 NHL and 9 AML) from May, 2008 to December, 2008. All patients were in complete remission and without significant organ failure. They received conditioning regimen (CEAM for NHL and HL, Busulfan and Etoposide for AML) and stem cell infusion in hospital. The day after SCT, the outpatient group was discharged and followed up by an outpatient SCT team to be re-hospitalized, if indicated.
Results: For outpatients and inpatients, the median period to WBC engraftment was 11 and 12 days (p-value=0.03), the timeframe to PLT engraftment was 15 and 25 days (p-value=0.20) and the number of transfused single-donor PLT was 3 and 4.5 units (p-value=0.21). The duration of neutropenic fever was 6 and 9 days (p-value=0.001), the duration of hospitalization after SCT was 0 and 16 (p-value<0.001), respectively. All outpatients are alive but three inpatients died between days +35 and +100 following SCT due to transplantation complications. The cost of the drugs used for treatment of neutropenic fever was 6 times higher in the inpatient group.
Conclusion: The outpatient autologous SCT in malignant hematological disorders is feasible and comparable to inpatient protocols in Iran.


Keywords


Outpatient; Autologous Stem Cell Transplantation; Malignant Hematologic Disorders

Full Text:

PDF

References


Barr RD. The Importance of Lowering the Costs of Stem Cell Transplantation in Developing Countries. Int J Hematol. 2002; 76, Suppl 1: 365-7.

Meisenberg BR, Ferran K, Hollenbach K, et al. Reduced Charges and Costs Associated with Outpatient Autologous Stem Cell Transplantation. Bone Marrow Transplant. 1998; 21(9): 927-32.

Gertz MA, Ansell SM, Dingli D, et al. Autologous Stem Cell Transplant in 716 Patients with Multiple Myeloma: Low Treatment-related Mortality, Feasibility of Outpatient Transplant, and Effect of a Multidisciplinary Quality Initiative. Mayo Clin Proc. 2008; 83(10): 1131-8. 4. Dix SP, Geller RB. High-dose Chemotherapy with Autologous Stem Cell Rescue in the Outpatient Setting. Oncology. 2000; 14(2): 171-85.

Cantú-Rodríguez OG, Jaime-Pérez JC, Gutiérrez-Aguirre CH, et al. Outpatient Allografting Using Non-myeloablative Conditioning: the Mexican Experience. Bone Marrow Transplant. 2007; 40(2): 119-23.

Leger C, Sabloff M, McDiarmid S, et al. Outpatient Autologous Hematopoietic Stem Cell Transplantation for Patients with Relapsed Follicular Lymphoma. Ann Hematol. 2006; 85(10): 723-9.

Summers N, Dawe U, Stewart DA. A Comparison of Inpatient and Outpatient ASCT. Bone Marrow Transplant. 2000; 26(4): 389-95.

Stiff P, Mumby P, Miler L, et al. Autologous Hematopoietic Stem Cell Transplants that Utilize Total Body Irradiation Can Safely be Carried out Entirely on an Outpatient Basis. Bone Marrow Transplant. 2006; 38(11): 757-64.

Rizzo JD, Vogelsang GB, Krumm S, et al. Outpatient-based Bone Marrow Transplantation for Hematologic Malignancies: Cost Saving or Cost Shifting? J Clin Oncol. 1999; 17(9): 2811-8.

Jagannath S, Vesole DH, Zhang M, et al. Feasibility and Cost-effectiveness of Outpatient Autotransplants in Multiple Myeloma. Bone Marrow Transplant. 1997; 20(6): 445-50.

Ferrara F, Palmieri S, Viola A, et al. Outpatient-based Peripheral Blood Stem Cell Transplantation for Patients with Multiple Myeloma. Hematol J. 2004; 5(3): 222-6.

Frey P, Stinson T, Siston A, et al. Lack of Caregivers Limits Use of Outpatient Hematopoietic Stem Cell Transplant Program. Bone Marrow Transplant. 2002; 30(11): 741-8.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.