Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Faculty of Medicine Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia.
Intern Med J. 2022 Jul;52(7):1242-1250. doi: 10.1111/imj.15334. Epub 2022 May 31.
Several international centres have published their experiences with outpatient autologous stem cell transplantation (ASCT) as treatment of haematological malignancies.
In this single-centre retrospective review, we aim to examine the outcomes of outpatient autograft and review healthcare resource utilisation in the pre-cytopenic period.
Patients undergoing ASCT in Royal Hobart Hospital, Tasmania between 2008 and 2018 had their records reviewed and key outcomes data collected based on whether they received inpatient/outpatient ASCT. An outpatient ASCT was defined as conditioning as an outpatient; patients could then be managed with an elective admission during the cytopenic period or admission only when clinically indicated.
Of 231 ASCT performed, 135 (58%) were as outpatients: 59 used carmustine-etoposide-cytarabine-melphalan conditioning for lymphoma (BEAM-ASCT) and 76 used high-dose melphalan for myeloma and amyloidosis (MEL-ASCT). Approximately one-third of patients undergoing outpatient ASCT were admitted electively during nadir period; the majority of patients required minimal interventions prior to this time. The most common causes for unplanned hospitalisation (which occurred in 71 (80%) of the 89 planned outpatient transplants) were febrile neutropenia (39%) and mucositis (35%). Age was the only risk factor identified to increase risk of requiring unplanned hospitalisation. Use of oral antibiotic prophylaxis reduced febrile neutropenia rates among melphalan outpatient ASCT. Outpatient ASCT led to significantly reduced inpatient bed-days and overall cost (approximately A$13 000-A$16 000) compared with inpatient autografts, with no significant differences in engraftment, rates of febrile neutropenia, intensive care admissions or mortality.
Outpatient autografts may save healthcare resources without compromising patient outcomes.
几家国际中心已经发表了他们在门诊自体干细胞移植（ASCT）治疗血液系统恶性肿瘤方面的经验。
在这项单中心回顾性研究中，我们旨在检查门诊自体移植的结果，并审查预细胞减少期的医疗资源利用情况。
在 2008 年至 2018 年期间，在塔斯马尼亚州皇家霍巴特医院接受 ASCT 的患者对其记录进行了审查，并根据他们是否接受门诊/住院 ASCT 收集了关键结果数据。门诊 ASCT 的定义是作为门诊进行预处理；在此期间，患者可以选择择期入院，也可以仅在临床需要时入院。
在 231 例 ASCT 中，有 135 例（58%）为门诊患者：59 例使用卡莫司汀-依托泊苷-阿糖胞苷-马法兰（BEAM-ASCT）治疗淋巴瘤，76 例使用大剂量马法兰治疗骨髓瘤和淀粉样变性（MEL-ASCT）。大约三分之一的门诊 ASCT 患者在最低点期间择期入院；在此之前，大多数患者需要进行最少的干预。计划门诊移植中，71 例（80%）无计划住院的最常见原因是发热性中性粒细胞减少症（39%）和粘膜炎（35%）。年龄是唯一确定需要无计划住院治疗风险增加的危险因素。口服抗生素预防可降低马法兰门诊 ASCT 中发热性中性粒细胞减少症的发生率。与住院自体移植相比，门诊 ASCT 可显著减少住院天数和总体费用（约 13000-16000 澳元），而植入率、发热性中性粒细胞减少症发生率、重症监护病房入院率或死亡率没有显著差异。
门诊自体移植可以节省医疗资源，而不会影响患者的治疗效果。
