Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Division of Medicine, Thonburi Hospital, Bangkok, 10700, Thailand.
BMC Cancer. 2018 Nov 16;18(1):1126. doi: 10.1186/s12885-018-5054-6.
Outpatient autologous stem cell transplantations (ASCTs) in multiple myeloma and lymphoma patients have been shown to reduce the overall costs and improve the quality of life relative to inpatient ASCTs. This systematic review and meta-analysis was performed with the aim of comprehensively comparing the risk of febrile neutropenia developing in ASCT outpatients and inpatients who have multiple myeloma or lymphoma.
To be eligible for the meta-analysis, studies needed to be either randomized, controlled studies or cohort studies. They also need to have two groups of patients with multiple myeloma or lymphoma who underwent ASCT, with the treatment being provided to one group in an outpatient setting and to the other on an inpatient basis. The studies had to report our primary outcome of interest, the rate of febrile neutropenia after stem cell infusion, for both groups. The Mantel-Haenszel method was used to pool the effect estimates and 95% confidence intervals of each study.
From 9 eligible studies, a total of 1940 patients were included in the meta-analysis. Contrary to conventional concerns, the patients who underwent the outpatient ASCT had a significantly lower risk of developing febrile neutropenia than those admitted for ASCT, with a pooled odds ratio (OR) of 0.44 (95% confidence interval [CI]: 0.29-0.65; p < 0.0001; I = 52%). The risk of septicemia was also significantly lower for the outpatients than the inpatients, with a pooled OR of 0.40 (95% CI: 0.16-0.97; p = 0.04; I = 23%). Additional analyses found that the odds of having grade 2-3 mucositis and transplant-related mortality were numerically lower for the outpatient group, although the pooled result was not statistically significant. The odds of surviving at 2-3 years was also numerically higher for the ASCT outpatients, but the difference did not reach statistical significance.
This study found a significantly lower odds of developing febrile neutropenia and septicemia among patients with multiple myeloma and lymphoma who received an outpatient ASCT than among those who had an inpatient ASCT.
多项骨髓瘤和淋巴瘤患者的门诊自体干细胞移植（ASCT）已被证明可以降低总体成本并提高生活质量，与住院 ASCT 相比。本系统评价和荟萃分析旨在全面比较多发性骨髓瘤和淋巴瘤患者门诊和住院接受 ASCT 后发生发热性中性粒细胞减少症的风险。
要符合荟萃分析的条件，研究需要是随机对照研究或队列研究。它们还需要有两组接受 ASCT 的多发性骨髓瘤或淋巴瘤患者，一组在门诊接受治疗，另一组在住院接受治疗。研究必须报告我们的主要观察结果，即干细胞输注后发热性中性粒细胞减少症的发生率，对于两组患者都要报告。采用 Mantel-Haenszel 方法对每项研究的效应估计值和 95%置信区间进行汇总。
从 9 项合格研究中，共有 1940 名患者纳入荟萃分析。与传统观点相反，接受门诊 ASCT 的患者发生发热性中性粒细胞减少症的风险明显低于住院接受 ASCT 的患者，汇总优势比（OR）为 0.44（95%置信区间[CI]：0.29-0.65；p<0.0001；I=52%）。门诊患者发生败血症的风险也明显低于住院患者，汇总 OR 为 0.40（95% CI：0.16-0.97；p=0.04；I=23%）。进一步分析发现，门诊组发生 2-3 级黏膜炎和移植相关死亡率的可能性略低，尽管汇总结果无统计学意义。门诊 ASCT 患者在 2-3 年时的生存率也略高，但差异无统计学意义。
本研究发现，与住院 ASCT 相比，多发性骨髓瘤和淋巴瘤患者接受门诊 ASCT 的患者发生发热性中性粒细胞减少症和败血症的几率显著降低。
