Outpatient autologous stem cell transplantation in Royal Hobart Hospital, Tasmania: a single-centre, retrospective review in the Australian setting.

Autor: Tan XN; Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.; Faculty of Medicine Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia.; Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia., Yew CY; Department of Anaesthesia, Armadale Health Service, Perth, Western Australia, Australia.; Department of Anaesthesia, Royal Hobart Hospital, Hobart, Tasmania, Australia.; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia., Ragg SJ; Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia.; University of Tasmania, Australia., Harrup RA; Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia.; University of Tasmania, Australia., Johnston AM; Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia.; University of Tasmania, Australia.
Jazyk: angličtina
Zdroj: Internal medicine journal [Intern Med J] 2022 Jul; Vol. 52 (7), pp. 1242-1250. Date of Electronic Publication: 2022 May 31.
DOI: 10.1111/imj.15334
Abstrakt: Background: Several international centres have published their experiences with outpatient autologous stem cell transplantation (ASCT) as treatment of haematological malignancies.
Aim: In this single-centre retrospective review, we aim to examine the outcomes of outpatient autograft and review healthcare resource utilisation in the pre-cytopenic period.
Methods: Patients undergoing ASCT in Royal Hobart Hospital, Tasmania between 2008 and 2018 had their records reviewed and key outcomes data collected based on whether they received inpatient/outpatient ASCT. An outpatient ASCT was defined as conditioning as an outpatient; patients could then be managed with an elective admission during the cytopenic period or admission only when clinically indicated.
Results: Of 231 ASCT performed, 135 (58%) were as outpatients: 59 used carmustine-etoposide-cytarabine-melphalan conditioning for lymphoma (BEAM-ASCT) and 76 used high-dose melphalan for myeloma and amyloidosis (MEL-ASCT). Approximately one-third of patients undergoing outpatient ASCT were admitted electively during nadir period; the majority of patients required minimal interventions prior to this time. The most common causes for unplanned hospitalisation (which occurred in 71 (80%) of the 89 planned outpatient transplants) were febrile neutropenia (39%) and mucositis (35%). Age was the only risk factor identified to increase risk of requiring unplanned hospitalisation. Use of oral antibiotic prophylaxis reduced febrile neutropenia rates among melphalan outpatient ASCT. Outpatient ASCT led to significantly reduced inpatient bed-days and overall cost (approximately A$13 000-A$16 000) compared with inpatient autografts, with no significant differences in engraftment, rates of febrile neutropenia, intensive care admissions or mortality.
Conclusion: Outpatient autografts may save healthcare resources without compromising patient outcomes.
(© 2021 Royal Australasian College of Physicians.)
Databáze: MEDLINE
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