Outpatient-based peripheral blood stem cell transplantation for patients with multiple myeloma

There is a growing demand for autologous stem cell transplantation (ASCT) in newly diagnosed patients with multiple myeloma (MM), resulting in an increasing pressure on available hospital beds. In addition, more rational utilization of health resources should induce physicians to attempt therapeutic strategies aiming at reduction of costs. The aim of this study was to explore the feasibility and safety of performing ASCT on an outpatient basis, according to an early discharge method.

A total of 28 patients affected by MM and in complete or partial remission were selected to receive ASCT on an outpatient basis. In particular, after conditioning with high-dose melphalan and stem cell infusion, patients were programmed to go home and to be rehospitalized in the case of febrile neutropenia or other severe toxicities.

All patients accepted the outpatient-based procedure. Out of 28 patients. 18 (64%) did spend the aplastic phase entirely at home following high-dose chemotherapy and stem cell infusion. A second hospital admission was required in 10 patients (36%). Febrile neutropenia and severe mucositis needing total parenteral nutrition were the most frequent causes of hospitalization. However, there were no documented infections and either fever or mucositis was easily resolved at the time of hematopoietic recovery in all patients.

ASCT on an outpatient basis is feasible and safe in patients with MM. More than 60% of patients are manageable at home, provided that a caregiver is available.