Summary:High-dose chemotherapy and stem cell rescue is increasingly being delivered in the outpatient setting. Such intensive outpatient management programs have reduced the total hospital length of stay without compromising clinical outcomes. However, a detailed financial analysis of outpatient programs has not been performed. These data are the results of a prospective study of 94 patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplant in one of three settings: traditional inpatient, partial outpatient, total outpatient. Patients were allowed to choose their own treatment setting based upon the availability of a caregiver and personal preference. Total hospital length of stay and the actual cost and charges for each patient were monitored prospectively. The patients in the three groups were well balanced with regard to age and functional status prior to high-dose chemotherapy. The average length of stay was reduced from 17.3 to 8.2 to 2.7 days in the three different treatment settings (P Ͻ 0.01). Mean procedure costs were reduced from $39.7 thousand (US dollars) to $36.2 thousand to $29.4 thousand in the three treatment settings (P Ͻ 0.029). No differences in toxicity or overall response to therapy was noted. High-dose chemotherapy and stem cell rescue can be safely administered in the outpatient setting and results in significant cost savings. Keywords: bone marrow transplantation; costs; outpatient transplantation; charges High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has become an increasingly utilized therapy for a wide variety of malignant diseases. HDC/ASCR has attracted a high level of scrutiny due to the high charges and costs associated with the procedure. Indeed, in the United States it is common for this procedure to require third-party and even fourth-party review before being approved by insurers. 1 Among the reasons for the high costs of HDC/ASCR is the prolonged hospitalization traditionally required for this treatment. Even with the use of hematopoietic growth factors and mobilized blood progenitor cells, which have shortened neutropenia and allowed earlier hospital discharge, hospital stays of 16 to more than 30 days are typical. 2,3,4 Peters and colleagues, 5 at Duke University Medical Center, pioneered a structured outpatient bone marrow transplant program wherein patients received all their highdose chemotherapy as inpatients and then were discharged to a 7-day-a-week outpatient clinic located a short distance from the main hospital. These patients had stage 2-4 breast cancer and received a high-dose chemotherapy regimen which did not induce a significant rate of mucositis, esophagitis or enteritis. In that program, all outpatients were housed in a local hotel adjacent to the outpatient clinic. In 1993, the Scripps Clinic stem cell transplant program advanced this model to include patients with diseases other than breast cancer receiving other chemotherapy regimens with a higher incidence of mucositis. 6 Subsequently we developed a...

We studied escalating doses of recombinant human interleukin-1 beta (IL- 1 beta) alone and after a myelosuppressive dose of 5-fluorouracil (5- FU) in patients with gastrointestinal cancer. Transient neutropenia, monocytopenia, and lymphocytopenia were observed followed by a 1.3- to 6.0-fold (mean, 3.46-fold) dose-dependent neutrophil leukocytosis (P less than .00001) on the days of IL-1 beta administration. Increases in platelet counts were observed at a median of 14 days (range, 6 to 23) after IL-1 beta administration. Transient hypoglycemia, rebound hyperglycemia, elevations in serum cortisol, and C-reactive protein were observed. Side effects included fever, rigors, and headache in the majority of patients. Hypotension was observed in three of five patients at the highest dose level (0.1 micrograms/kg) and was dose- limiting. Fewer days of neutropenia were noted after 5-FU plus IL-1 beta than after 5-FU alone; however, this difference did not reach statistical significance. These data show that IL-1 beta has stimulatory effects in human hematopoiesis.

We studied escalating doses of recombinant human interleukin-1 beta (IL- 1 beta) alone and after a myelosuppressive dose of 5-fluorouracil (5- FU) in patients with gastrointestinal cancer. Transient neutropenia, monocytopenia, and lymphocytopenia were observed followed by a 1.3- to 6.0-fold (mean, 3.46-fold) dose-dependent neutrophil leukocytosis (P less than .00001) on the days of IL-1 beta administration. Increases in platelet counts were observed at a median of 14 days (range, 6 to 23) after IL-1 beta administration. Transient hypoglycemia, rebound hyperglycemia, elevations in serum cortisol, and C-reactive protein were observed. Side effects included fever, rigors, and headache in the majority of patients. Hypotension was observed in three of five patients at the highest dose level (0.1 micrograms/kg) and was dose- limiting. Fewer days of neutropenia were noted after 5-FU plus IL-1 beta than after 5-FU alone; however, this difference did not reach statistical significance. These data show that IL-1 beta has stimulatory effects in human hematopoiesis.