Long-term follow-up of patients treated at home during the pancytopenic phase after allogeneic haematopoietic stem cell transplantation

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

“…Of the 68 patients receiving allogeneic HSCT, only 8 patients (12%) received outpatient transplants, leaving questions regarding its generalizability. More recently, Svahn et al 4 reported on their experience with outpatient allogeneic HSCT in a selected group of patients treated at a single Swedish hospital, showing that this approach translated into lower TRM and reduced costs. Outpatient treatment was provided to 36 of 179 patients (20%) receiving allogeneic HSCT.…”

“…Although a potential for cost savings exists, it is more difficult to show, as much of the in-patient cost reduction is simply shifted to the outpatient setting. 19 However, several studies have documented a 25-45% decrease in total medical charges associated with an outpatient management strategy 4,9,14,19 that could translate into substantial savings if applied to a significant proportion of more than 15 000 patients receiving HSCT in North America each year (data from the Center for International Blood and Marrow Transplant Research).…”

“…Only 5 of 100 patients were admitted prospectively to receive their high-dose preparative regimen due to compliance (4) Post-transplant day Figure 1 Kaplan-Meier analysis of (a) relapse, overall and progressionfree survival for all patients, and (b) overall survival and relapse according to disease risk. (2) preparative regimen in the outpatient infusion center.…”

“…[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.…”

“…The severity of these complications has historically mandated in-patient delivery of care, and patients are traditionally hospitalized during the highdose preparative regimen until hematopoietic recovery and resolution of mucosal toxicity, with median length of initial hospitalization ranging from 25 to 30 days. [4][5][6] During the pancytopenic phase, patients are typically kept in a protective low-pathogen environment with the use of HEPA (high-efficiency particulate air) filtration systems.…”