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Developing a pediatric outpatient transplantation program. The Children's Memorial Hospital experience
L Gonzalez-Ryan1, P R Haut, K Coyne
1Children's Memorial Hospital, Stem Cell Transplant Program at Children's Memorial Hospital, 2300 Children's Plaza, Chicago IL 60614, USA.
Frontiers in Bioscience : a Journal and Virtual Library
|August 7, 2001
Summary
Pediatric outpatient hematopoietic stem cell transplants are feasible and cost-effective for autologous procedures, with no increase in morbidity or mortality. Further data is needed for allogeneic outpatient transplants.
Area of Science:
- Pediatric Hematology
- Transplant Immunology
- Health Services Research
Background:
- Establishing pediatric outpatient transplant programs is an evolving area in stem cell transplantation.
- Evaluating the safety, efficacy, and cost-effectiveness of outpatient models is crucial for program development.
Purpose of the Study:
- To describe the development of a pediatric outpatient transplant program.
- To report initial experiences with autologous and allogeneic transplants in an outpatient setting.
- To compare outcomes and costs between outpatient and inpatient transplant models.
Main Methods:
- Retrospective analysis of 48 autologous and 7 allogeneic transplants performed between June 1994 and July 2000.
- Comparison of specific chemotherapy regimens for autologous (VP-16/Carboplatinum) and allogeneic (Fludarabine/Busulfan/ATG) outpatient transplants versus inpatient autologous protocols.
- Evaluation of engraftment parameters (ANC, platelets, VNTRs), morbidity, mortality, and economic data.
Main Results:
- Engraftment times for autologous outpatient vs. inpatient transplants were similar (ANC >500 at 15 days).
- Platelet engraftment was faster in outpatients (day 19) compared to inpatients (day 32).
- Outpatient transplants showed statistically significant reductions in median charges ($30,775 vs. $99,838) and direct costs ($8,389 vs. $42,757) compared to inpatient procedures.
- No significant difference in morbidity or mortality was observed between outpatient and inpatient groups.
- Use of empiric amphotericin B was markedly decreased in outpatient transplants.
Conclusions:
- Autologous hematopoietic stem cell transplantation in the pediatric outpatient setting is feasible, cost-effective, and does not increase morbidity or mortality.
- The current data is insufficient to establish similar conclusions for allogeneic transplants in the outpatient setting.
- Outpatient models offer significant economic benefits and reduced resource utilization, particularly for autologous transplants.