Summary:chemotherapy does not exceed 5-10%. Advanced age (median, 65 years), renal function impairment and hematoThis report summarizes 2 years experience in perpoietic stem cell compromise due to prolonged alkylating forming 336 autotransplant procedures in 251 consecuagent therapy have delayed evaluation of high-dose chemotive patients with multiple myeloma, using high-dose therapy in MM, an approach that has proven to be successmelphalan at 200 mg/m 2 in the context of a tandem ful in the management of lymphomas. 2 Pilot studies in the transplant program. A total of 91 patients received 118 early 1980s revealed that drug-resistance in advanced MM transplants as outpatients while the remaining 160 could be overcome by dose-escalation of alkylating patients received 218 transplants as inpatients. Outagents. 3,4 As a result, numerous clinical trials have patients were more often younger, with better stem cell employed autologous stem cells, as well as colony-stimulatproducts, normal serum albumin and ␤-2-microglobuing factors, to support myeloablative therapy for MM. 5-9 A lin levels as well as chemotherapy-sensitive disease comrandomized clinical trial by French investigators has shown pared to inpatients. There were no differences in hemaautotransplant to be superior to standard chemotherapy in topoietic recovery and non-hematologic toxicities the management of newly diagnosed symptomatic myeloma between outpatient and inpatient transplant recipients.patients. 10 In the interest of offering this promising treatPost-transplant febrile neutropenia and most other ment strategy to a larger MM patient population, outpatient post-transplant toxicities were managed successfully in transplants were initiated at our institution and their safety, an ambulatory setting. Although liberal criteria were efficacy, and cost-effectiveness were examined. developed for hospitalization of outpatients, including High-dose melphalan was chosen as cytoreductive regiclinical parameters as well as patient desire and men because of its relative lack of extra-medullary toxicity, physician/nurse judgment, only 21% of outpatients even at 200 mg/m 2 . 11,12 The initiation of outpatient transrequired admission after transplantation. Median hosplants required a high degree of proficiency on the part of pital stay for these outpatients was 9 days, while inpathe transplant team and an adequate outpatient nursing and tients were hospitalized for a median of 15 days (P ‫؍‬ pharmacy infrastructure to ensure continuity of care, even 0.0001). After adjusting for differences in disease and at weekends. Because only two outpatient autotransplant host features, our study showed outpatient management procedures could be accommodated per week, patient perresulted in significant financial savings due to lower formance status and preference, as well as third-party pharmacy (42%), hospitalization (50%) and insurance payments influenced whether or not a patient was pathology/laboratory charges (36%). We conclude that accepted for outpatient transplantation....