Optimizing autologous stem cell transplantation for multiple myeloma: early step-down ward vs. HEPA-filtered room settings – a practical approach for resource-constrained settings

Abstract

Autologous stem cell transplantation (ASCT) is a cornerstone treatment for multiple myeloma, and its application is increasing. Despite extensive studies, outpatient ASCT remains challenging in developing countries due to elevated infection risks, socioeconomic limitations, and logistical hurdles. This retrospective and prospective study analyzed 232 patients who underwent ASCT between January 2017 and October 2023. Participants were allocated into two cohorts: patients treated in high-efficiency particulate air-filtered rooms until discharge (HEPA-filtered group) and those who transitioned to a step-down ward postinfusion (SD group). The baseline characteristics of the patients in the groups were comparable. The primary endpoints were the incidence of febrile neutropenia and serious infectious complications, while the secondary endpoints were intensive care unit transfer rates, re-admission rates, therapy-related mortality, and overall survival. The incidence rates of febrile neutropenia were similar (94%), as were the rates of severe infections (septicemia rate: 13%). There were no differences in therapy-related mortality (30 days: 0%, 100 days: 0%) or overall survival. The early transition to the SD ward reduced the median duration of HEPA-filtered room use to 4 days without adversely impacting morbidity or mortality. These outcomes endorse the feasibility of conducting ASCT in non-HEPA-filtered settings in resource-constrained environments.