| Abstrakt: |
BACKGROUND: Preparative regimens for patients undergoing allogeneic stem-cell transplant (SCT) in acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) have historically been administered in the inpatient setting. There are limited data on the administration of myeloablative and reduced-intensity preparative regimens in the outpatient setting. OBJECTIVE: To compare the incidence of 100-day nonrelapse mortality in patients with AML or MDS who received myeloablative or reduced-intensity preparative regimens for allogeneic SCT in the outpatient versus the inpatient setting. METHODS: This was a retrospective, comparative, single-center chart review of patients with AML or MDS who underwent allogeneic SCT in the inpatient versus outpatient settings. Patients with a matched sibling donor or matched unrelated donor received myeloablative busulfan plus cyclophosphamide or a reduced-intensity regimen with busulfan plus fludarabine. Patients undergoing a haploidentical transplant received fludarabine plus cyclophosphamide and total body irradiation. Patients who received their preparative regimen in the outpatient setting were admitted to the hospital on day 0 for stem-cell infusion. RESULTS: A total of 221 patients were included in the final analysis, including 89 patients who received their preparative chemotherapy regimen in the outpatient setting, and 132 patients who received their regimen in the inpatient unit. In the outpatient group, 15 (16.9%) patients received busulfan plus cyclophosphamide, 51 (57.3%) received busulfan plus fludarabine, and 23 (25.8%) received fludarabine plus cyclophosphamide and total body irradiation. In the inpatient group, 69 (52.3%) patients received busulfan plus cyclophosphamide, 35 (26.5%) received busulfan plus fludarabine, and 28 (21.2%) received fludarabine plus cyclophosphamide and total body irradiation. Outpatient administration was not associated with a decrease in 100-day nonrelapse mortality (outpatient, 8% vs inpatient, 7%; P = .844), and the progression-free survival (PFS) at 100 days was similar between the 2 groups. The median length of hospital stay was significantly lower in patients receiving a preparative regimen in the outpatient versus the inpatient setting (20 days vs 27 days, respectively; P <.001). The readmission rate before day 100 was 35.2% in the outpatient setting versus 42.3% in the inpatient cohort (P = .559). CONCLUSION: Myeloablative and reduced-intensity preparative regimens can be safely administered in the outpatient setting, with outcomes of 100-day nonrelapse mortality, 100-day PFS, and readmissions before day 100 that are comparable with regimens administered in the inpatient setting. [ABSTRACT FROM AUTHOR] |
