Safe and effective use of outpatient non-myeloablative allogeneic stem cell transplantation for myeloma

Campbell, Philip; Walker, Patricia; Avery, Sharon; Patil, Sushrut; Curtis, David J.; Schwarer, Anthony P.; Wei, Andrew H.; Kalff, Anna; Muirhead, Jenny; Spencer, Andrew

doi:10.1038/bcj.2014.33

Cited by 11 publications

(10 citation statements)

References 11 publications

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“…In our present study we found that outpatient RIC allo-HCT resulted in substantial cost savings within the first 100 days of transplant compared with the inpatient cohort. Additionally, about 50% of patients in the outpatient cohort never required hospitalization through day +100, similar to other reports [23]. It is important to understand the difference between cost and charges in this setting.…”

Section: Discussionsupporting

confidence: 83%

Outcomes of Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Performed in the Inpatient versus Outpatient Setting

Murthy

Hari

Szabó

et al. 2019

Biology of Blood and Marrow Transplantation

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A B S T R A C T Allogeneic hematopoietic cell transplantation (allo-HCT) with reduced-intensity conditioning (RIC) is commonly performed as an inpatient procedure. The feasibility and outcomes of RIC allo-HCT in the outpatient setting is not known. We performed a single-center retrospective cohort study of patients aged 18 years with hematologic malignancies who underwent RIC allo-HCT either in the inpatient or outpatient setting. Donor types included HLA-matched sibling and well-matched unrelated donors. The objectives were to compare the survival, complications, charges, and incidences of relapse, nonrelapse mortality (NRM), and acute and chronic graft-versus-host disease (GVHD) between the 2 groups. Between 2014 and 2017, 151 eligible patients were included, with 116 undergoing RIC allo-HCT in the inpatient setting and 35 patients undergoing RIC allo-HCT in the outpatient setting. Baseline characteristics were comparable between the 2 groups except for a higher proportion of patients with myeloma in the outpatient cohort (inpatient 15.5% versus outpatient 37.1%). The cumulative incidence of grades II to IV acute GVHD (inpatient 25.2% versus outpatient 25.7%), grades III to IV acute GVHD (inpatient 10.4% versus outpatient 8.5%), chronic GVHD (inpatient 38.3% versus outpatient 51.6%), NRM at 1 year (inpatient 10.8% versus outpatient 3.2%), and relapse (inpatient 24.8% versus outpatient 33.2%) did not significantly differ between the 2 cohorts. One-year progression-free survival (inpatient 64.4% versus outpatient 63.6%, P = .39) and overall survival (inpatient 73.8% versus outpatient 82.8%, P = .93) were also not significantly different between the 2 groups. The proportion of patients who developed neutropenic fever (inpatient 25.8% versus outpatient 8.5%, P = .03) and mucositis (inpatient 50.8% versus outpatient 8.5%, P < .001) and who required total parenteral nutrition (inpatient 20.6% versus outpatient 5.7%, P = .04) were more frequent in the inpatient cohort. About 51.5% of the outpatient cohort never required hospital admission in the first 100 days. Outpatient HCT resulted in significantly lower charges than inpatient HCT in the first 100 days (median charges: inpatient $339,621 versus outpatient $247,334; P < .001). On multivariate analysis the site of the HCT (outpatient versus inpatient) was not a significant predictor of either overall or progression-free survival. Outpatient RIC allo-HCT is feasible and safe with daily outpatient evaluation and aggressive supportive care resulting in outcomes comparable with those who received the transplant in the inpatient setting.

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Section: Discussionsupporting

confidence: 83%

Outcomes of Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Performed in the Inpatient versus Outpatient Setting

Murthy

Hari

Szabó

et al. 2019

Biology of Blood and Marrow Transplantation

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“…A meta‐analysis described that up to 41% of patients take their chronic medication for less than 80% of the days’ on therapy in a year . With improvements in supportive care, HCT is increasingly being offered in outpatient settings . The transition in the immediate post‐HCT period poses risks to these patients on potential underuse of their chronic medications, especially in the fragmented U.S. health system where multiple studies indicate that the rate of adherence to oral medications decrease over time …”

Section: Hypothesis and Objectivementioning

confidence: 99%

“…4 With improvements in supportive care, HCT is increasingly being offered in outpatient settings. 5,6 The transition in the immediate post-HCT period poses risks to these patients on potential underuse of their chronic medications, especially in the fragmented U.S. health system where multiple studies indicate that the rate of adherence to oral medications decrease over time. 7 A recent systematic review indicated that nonadherence to oral medications ranged from 5.3% to 67% among patients undergoing HCT, primarily in smaller institutional cohorts or registry-based studies.…”

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confidence: 99%

Discontinuation and Nonadherence to Medications for Chronic Conditions after Hematopoietic Cell Transplantation: A 6‐Year Propensity Score–Matched Cohort Study

et al. 2019

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Introduction Hematopoietic cell transplantation (HCT) is an established curative option for patients with hematological malignancies and other life‐threatening conditions. Evidence on nonpersistence and nonadherence to oral medications for chronic conditions among patients following HCT is lacking. Objectives This study aims to examine patterns of oral medication use for chronic conditions following HCT in the U.S. population. Methods Nonpersistence and nonadherence to oral medications for diabetes, hypertension, and dyslipidemia among HCT recipients were assessed in a cohort that included 1382 autologous and 650 allogeneic HCT recipients with hematological malignancies using the Truven Health MarketScan Research Database between 2009 and 2014. Recipients of HCT were compared to propensity score–matched cancer patients receiving chemotherapy without transplantation. Multivariable Cox proportional hazards models and generalized estimating equations were used to determine characteristics associated with nonpersistence and nonadherence to oral chronic medications, respectively. Results Recipients of HCT had higher risks of discontinuing medication for diabetes mellitus (allogeneic HCT hazard ratio [HR] = 1.93, 95% confidence interval [CI] 1.10–3.39; autologous HCT HR = 1.49, 95% CI 1.04–2.15); hypertension (allogeneic HCT HR = 1.75, 95% CI 1.21–2.53; autologous HCT HR = 1.32, 95% CI 1.07–1.62), and dyslipidemia (allogeneic HCT HR = 2.02, 95% CI 1.39–2.93; autologous HCT, HR = 1.26, 95% CI 0.98–1.61) compared to patients treated with only chemotherapy. Lower odds of adherence to antihypertensive medications (odds ratio [OR] = 0.58, 95% CI 0.38–0.89) and to lipid‐lowering medications (OR = 0.38, 95% CI 0.22–0.65) were observed in allogeneic HCT recipients compared with propensity score–matched patients who underwent chemotherapy only. Conclusions Poor medication persistence and adherence to chronic disease medications are common after HCT. Further research to improve long‐term outcomes following HCT should include management of medication therapy for chronic comorbid conditions.

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“…Thus, various factors related to the arrangement of care were shown to influence the feeling of being safe, regardless of care setting. Comparison with other centers [24][25][26][27]124,125 is difficult because of large variations in how home care and outpatient care are performed, as well as the absence of patients reported experiences of care. But the current work suggests the care at Karolinska University Hospital provides good support and encouragement so the patient and family members could feel safe and secure knowing that they would be given the best care.…”

Section: Being Safe In Different Care Settingsmentioning

confidence: 99%

General health, symptom occurrence, and self-efficacy in adult survivors after allogeneic hematopoietic stem cell transplantation: a cross-sectional comparison between hospital care and home care

Bergkvist

Winterling

Johansson

et al. 2014

Support Care Cancer

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Safe and effective use of outpatient non-myeloablative allogeneic stem cell transplantation for myeloma

Cited by 11 publications

References 11 publications

Outcomes of Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Performed in the Inpatient versus Outpatient Setting

Outcomes of Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Performed in the Inpatient versus Outpatient Setting

Discontinuation and Nonadherence to Medications for Chronic Conditions after Hematopoietic Cell Transplantation: A 6‐Year Propensity Score–Matched Cohort Study

General health, symptom occurrence, and self-efficacy in adult survivors after allogeneic hematopoietic stem cell transplantation: a cross-sectional comparison between hospital care and home care

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