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

Area of Science:

• Hematology
• Oncology
• Transplant Medicine

Background:

• Myeloablative allogeneic hematopoietic stem cell transplant (HSCT) traditionally requires prolonged hospitalization due to toxicity and cytopenias.
• Outpatient management strategies for HSCT are being explored to improve patient experience and resource utilization.

Purpose of the Study:

• To evaluate the safety and feasibility of an outpatient management model for myeloablative allogeneic HSCT.
• To assess clinical outcomes, including morbidity and mortality, in patients managed with this approach.

Main Methods:

• A prospective study of 100 consecutive patients undergoing myeloablative allogeneic HSCT for hematologic malignancy.
• Patients were hospitalized briefly for infusion and managed as outpatients, with readmission for complications.
• Key metrics included length of stay, readmission rates, causes for readmission, and non-relapse mortality.

Main Results:

• Median length of stay to day +30 and day +100 was 12 and 15 days, respectively.
• 79% of patients were discharged after infusion, with a median readmission on day +7, primarily for neutropenic fever.
• 18% of patients required no inpatient care within the first 100 days; non-relapse mortality was 10% at day 100 and 15% at 6 months.

Conclusions:

• Outpatient myeloablative allogeneic HSCT with expectant inpatient management is safe and feasible.
• This model demonstrates low treatment-related morbidity and mortality, with clinical outcomes comparable to traditional inpatient HSCT.
• Outpatient management represents a viable alternative for select HSCT patients, potentially improving care efficiency.