Department of Medicine, Hematology-Oncology, University of California San Francisco, San Francisco, CA, USA.
Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Eur J Haematol. 2017 Dec;99(6):532-535. doi: 10.1111/ejh.12970. Epub 2017 Oct 8.
High-dose chemotherapy and autologous hematopoietic stem cell transplantation (auto-HCT) are commonly performed for multiple myeloma (MM) patients and may be as safe in the outpatient setting as in the inpatient setting.
We performed a single-center retrospective analysis of all MM patients undergoing auto-HCT between January 2008 and December 2012. We categorized patients as outpatient vs inpatient auto-HCT and compared clinical characteristics and outcomes between the groups.
One thousand and forty-six patients were included (669 inpatients, 377 outpatients). Patients transplanted as outpatients were significantly younger (58 [34-78] vs 62 [31-82], P < .001) and more likely to have an hematopoietic stem cell comorbidity index (HCT-CI) score <2 (P = .003) and creatinine <2 (P < .001). There were no differences in treatment-related mortality (TRM) but the inpatient group experienced significantly more grade 2-5 (P = .003) and grade 3-5 (P = .003) adverse events (AEs). 2 year progression-free survival (PFS) was significantly longer in the outpatient group (60% vs 50%, HR =HR 0.7, 95% CI 0.6-0.9, P = .005). 2 year OS was also longer in the outpatient group (83% vs 77%, HR 0.6, 95% CI 04-0.9, P = .01).
Outpatient auto-HCT can be safely performed for selected patients with MM. Differences in outcomes are likely related to baseline clinical characteristics rather than choice of treatment setting.
高剂量化疗和自体造血干细胞移植（auto-HCT）常用于多发性骨髓瘤（MM）患者，在门诊环境中与住院环境中一样安全。
我们对 2008 年 1 月至 2012 年 12 月期间接受 auto-HCT 的所有 MM 患者进行了单中心回顾性分析。我们将患者分为门诊 auto-HCT 和住院 auto-HCT，并比较两组的临床特征和结局。
共纳入 1046 例患者（669 例住院患者，377 例门诊患者）。门诊移植患者年龄明显更小（58 [34-78] 岁 vs 62 [31-82] 岁，P<0.001），更可能具有造血干细胞合并症指数（HCT-CI）评分<2（P=0.003）和肌酐<2（P<0.001）。两组治疗相关死亡率（TRM）无差异，但住院组更易发生 2-5 级（P=0.003）和 3-5 级（P=0.003）不良事件（AE）。门诊组 2 年无进展生存（PFS）明显更长（60% vs 50%，HR=0.7，95%CI 0.6-0.9，P=0.005）。门诊组 2 年总生存（OS）也更长（83% vs 77%，HR 0.6，95%CI 0.4-0.9，P=0.01）。
对于选择的 MM 患者，门诊 auto-HCT 可以安全进行。结局的差异可能与基线临床特征有关，而与治疗环境的选择无关。
