High-dose chemotherapy followed by autologous blood cell transplantation: a safe and effective outpatient approach

Abstract

led us to investigate the feasibility of early discharge and outpatient follow-up. High-dose chemotherapy (HDCT) followed by autologous blood cell (ABC) transplantation has been used Accordingly, a three-step approach was planned and executed. The results of this study are reported here. widely for patients with metastatic breast cancer (MBC). It has been shown by our group and others to be an effective means of achieving very high response rates including complete remission. Therefore, furtherPatients and methods reduction in toxicity and increased patient satisfaction is necessary. Fifty-three patients with MBC wereBetween January 1994 and December 1995, a total of 53 patients were enrolled in this feasibility study using HDCT enrolled in a feasibility study at our cancer centre with a three-step approach to outpatient observation after with ABC support for MBC. HDCT was delivered to patients between 18-55 (median 40) years of age who HDCT and ABC transplantation discharging our patients from hospital 6 days after reinfusion of ABC, qualified for our clinical trials. Patients with CNS involvement were excluded. All patients had chemosensitive dis-1 day after reinfusion of ABC and 1 day prior to reinfusion of ABC. The supportive care consisted of the use ease and underwent successful apheresis after mobilization methods as described previously. 10 The apheresis product of 5-HT3 antagonists for nausea and vomiting, DMSO depletion, thorough body hygiene, prophylactic antiobtained was cryopreserved in 10% dimethylsulfoxide (DMSO) and stored in liquid nitrogen until required. 10 biotic, antifungal and virustatic drugs. In the event of febrile neutropenia, a standard evaluation and treat-The HDCT consisted of cyclophosphamide (CY) 6 mg/m 2 ; mitoxantrone 70 mg/m 2 ; and one of the following ment was used. Only 22 patients were admitted for febrile neutropenia and two for haemorrhage. The three drugs: vinblastine 12 mg/m 2 , carboplatin 800 mg/m 2 , or paclitaxel between 250-400 mg/m 2 . This high-dose treatmedian hospital stay was 2 days (range 1-7). The time to engraftment, need for transfusion and other toxicities ment was delivered on 4 consecutive days. After a day of rest, the ABCs were prepared as previously described and were not different in patients who stayed entirely as outpatients. No toxic deaths occurred. In conclusion, reinfused. 10 Since the introduction of DMSO depletion, 11 the nausea, vomiting, and cardiovascular symptoms during HDCT followed by ABC transplantation can be safely administered to patients in the clinic with outpatient and after transplantation, have almost entirely disappeared. When we began using recombinant human granulocyte colpost-transplant observation. Keywords: high-dose chemotherapy; breast cancer; outony-stimulating factor (rhG-CSF) instead of recombinant human granulocyte-macrophage colony-stimulating factor patient transplantation (rhGM-CSF), no growth factor-induced fever was observed. 12 The haematologic recovery after reinfusion of ABC was supported by administration o...

Outpatient myeloablative allo-SCT: a comprehensive approach yields decreased hospital utilization and low TRM

“…Since the early 1990s, there have been several published reports of successful outpatient-based autologous HSCT. [7][8][9][10][11][12][13][14][15] The experience with outpatient management of allogeneic HSCT has been quite limited outside the context of nonmyeloablative HSCT. [16][17][18] The group at John Hopkins reported on an in-patient-outpatient continuumof-care model for both autologous and allogeneic HSCT that resulted in a substantial cost savings, particularly in patients with standard risk disease, without an increase in clinical complications.…”

“…Several groups have shown that autologous HSCT can be safely delivered in the outpatient setting with good outcomes and diminished cost. [7][8][9][10][11][12][13][14][15] In addition, allogeneic transplantation after nonmyeloablative conditioning also seems feasible in the ambulatory care setting, [16][17][18] given its significantly reduced regimen-related toxicities compared with standard allogeneic HSCT. A few pilot studies have explored the safety of outpatient myeloablative allogeneic HSCT 4,19 in small numbers of selected patients, but none have documented whether this approach is generalizable to the majority of patients requiring such therapy.…”

Performing allogeneic and autologous hematopoietic SCT in the outpatient setting: effects on infectious complications and early transplant outcomes

“…3,4 A growing number of studies showing the feasibility, safety and cost reduction of OP auto-HSCT in patients with hematological malignancies have led to an increased acceptance of this approach. [5][6][7][8] However, extension of this model into the allogeneic (allo)-HSCT transplant population has not occurred. An early publication by Russell et al 9 described 50 consecutive patients receiving an allo-HSCT, nursed in a single room that included a subset of patients who were allowed to go home during their neutropenic phase.…”

Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs

“…Over the past decade, a number of studies have investigated the efficacy, safety and cost advantages of reduced hospitalization for auto-SCT. [5][6][7][8][9][10][11][12][13][14][15][16][17] During this time several models of outpatient (home-and clinic-based or daily clinic-based) and early discharge care (with or without planned readmission) have emerged. 18 Studies usually conclude that HDCT is feasible and safe in the outpatient setting, thanks to the use of hematopoietic growth factors and antimicrobial prophylaxis, which lower aplasia related complications.…”