Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, BC Cancer, Vancouver, BC, Canada.
Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, BC Cancer, Vancouver, BC, Canada.
Clin Lymphoma Myeloma Leuk. 2019 Dec;19(12):784-790. doi: 10.1016/j.clml.2019.09.619. Epub 2019 Oct 9.
Autologous stem cell transplant (ASCT) is the preferred consolidation strategy to treat eligible patients with multiple myeloma (MM) and related plasma cell dyscrasias. Given the increasing volume of patients and longer wait time, outpatient ASCT for MM is the standard of care at the Vancouver General Hospital.
Patients with MM, POEMS syndrome, and amyloidosis undergoing ASCT were included in this analysis. We analyzed patient characteristics, the number of patients requiring admission, duration of admission, 30-day and 100-day mortality, and overall survival.
Between January 2007 and June 2016, 724 patients underwent 752 ASCTs. Of these, 702 were first ASCTs, 44 were second, and 6 were third. The median age was 60 years (interquartile range [IQR], 54-65 years). Reasons for ASCTs were MM (96.9%) amyloidosis (2.4%), and POEMS syndrome (0.7%). There were 431 (59.5%) males in this group. The median time from diagnosis to transplant was 5 months. Conditioning was melphalan 200 mg/m for 89.6% of the patients. Admission to the inpatient ward was required by 245 (32.6%) patients within the first 30 days. The median time to admission was 9 days post-transplant (IQR, 5-13 days). The median duration of admission was 6 days (IQR, 3-9 days). The day 100 all-cause mortality rate was 0.9%, and transplant-related mortality was 0.4%.
Outpatient ASCT is a safe and feasible treatment strategy with low transplant-related mortality. Overall resource utilization is significantly lower than inpatient ASCT: however, this requires a multidisciplinary approach with close follow-up.
自体干细胞移植（ASCT）是治疗多发性骨髓瘤（MM）和相关浆细胞异常患者的首选巩固策略。由于患者数量不断增加且等待时间延长，温哥华综合医院将门诊 ASCT 作为 MM 的标准治疗方法。
本分析纳入了接受 ASCT 的 MM、POEMS 综合征和淀粉样变性患者。我们分析了患者特征、需要住院的患者数量、住院时间、30 天和 100 天死亡率以及总生存率。
2007 年 1 月至 2016 年 6 月期间，724 例患者进行了 752 例 ASCT。其中，702 例为首次 ASCT，44 例为二次 ASCT，6 例为三次 ASCT。中位年龄为 60 岁（四分位距 [IQR]，54-65 岁）。ASCT 的原因是 MM（96.9%）、淀粉样变性（2.4%）和 POEMS 综合征（0.7%）。该组中有 431 例（59.5%）男性。从诊断到移植的中位时间为 5 个月。89.6%的患者采用美法仑 200mg/m 作为预处理方案。在最初的 30 天内，有 245 例（32.6%）患者需要住院治疗。住院时间中位数为移植后第 9 天（IQR，5-13 天）。住院时间中位数为 6 天（IQR，3-9 天）。100 天全因死亡率为 0.9%，移植相关死亡率为 0.4%。
门诊 ASCT 是一种安全可行的治疗策略，移植相关死亡率低。总体资源利用率明显低于住院 ASCT：然而，这需要多学科方法和密切随访。
