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Outpatient ASCT Safe, Results in Lower Rates of Febrile Neutropenia and Septicemia

David Bai, PharmD
Patients who undergo outpatient autologous stem cell transplantations (ASCTs) not only report lower costs and higher satisfaction, but they also have lower odds of developing febrile neutropenia and septicemia than patients who undergo inpatient ASCT, according to the results of a new analysis.
Autologous stem cell transplantation (ASCT) provides a therapeutic option for patients with multiple myeloma and lymphoma who are eligible for transplantation and achieved at least a partial response after combination chemotherapy. Although it can improve overall prognosis, it also has short-term complications, hospitalization, and high expenses. The first ASCT outpatient program was developed in 1993 in order to reduce costs and improve the quality of life for patients who require the transplantation.

Despite its benefits, outpatient ASCT has not been widely practiced because of concern over the risk of infection form a nonisolated practice site. However, patients who undergo outpatient ASCTs not only report lower costs and higher satisfaction, but they also have lower odds of developing febrile neutropenia and septicemia than patients who undergo inpatient ASCT, according to the results of a new analysis.

The meta-analysis included 9 studies, comprising of 1940 patients (740 in the outpatient-ASCT arm and 1200 in the inpatient-ASCT arm). Approximately 80% of the patients had multiple myeloma, 12.5% had lymphoma, and 0.9% had other hematologic malignancies. Two of the main end points observed were febrile neutropenia and septicemia.

After reviewing the data, investigators found that patients who underwent an outpatient ASCT had significantly lower odds of developing febrile neutropenia than patients who underwent an inpatient ASCT (odds ratio [OR] 0.44; 95% CI 0.29-0.65; P < .0001). The risk of septicemia was also significantly lower for outpatients than inpatients (OR 0.40, 95% CI 0.16-0.97, P = .04).

Complications, such as grade 2-3 mucositis and transplant-related mortality, were lower in the outpatient ASCT group as well, although these differences did not reach statistical significance (mucositis, P = .14; TRM, P = .12). Long term outcomes also favored outpatient ASCT, with the odds of surviving at 2-3 years being higher than for inpatient ASCT; however, this also did not reach statistical significance (P = .16).

This meta-analysis is the first to pool together a multitude of studies and conclude that patients who underwent outpatient ASCT had significantly lower odds at developing febrile neutropenia and septicemia than patients who underwent inpatient ASCT. Because of the cost savings and higher patient satisfaction rates, outpatient ASCT should utilized in more patients with multiple myeloma and lymphoma when the resources are available.

Reference:

Owattanapanich W, Suphadirekkul K, Kunacheewa C, Ungprasert P, Prayongratana K. Risk of febrile neutropenia among patients with multiple myeloma or lymphoma who undergo inpatient versus outpatient autologous stem cell transplantation: a systematic review and meta-analysis. BMC Cancer. 2018;18(1):1126. doi: 10.1186/s12885-018-5054-6.

 
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