Jagannath S, Vesole D H, Zhang M, Desikan K R, Copeland N, Jagannath M, Bracy D, Jones R, Crowley J, Tricot G, Barlogie B
Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
Bone Marrow Transplant. 1997 Sep;20(6):445-50. doi: 10.1038/sj.bmt.1700900.
This report summarizes 2 years experience in performing 336 autotransplant procedures in 251 consecutive patients with multiple myeloma, using high-dose melphalan at 200 mg/m2 in the context of a tandem transplant program. A total of 91 patients received 118 transplants as outpatients while the remaining 160 patients received 218 transplants as inpatients. Outpatients were more often younger, with better stem cell products, normal serum albumin and beta-2-microglobulin levels as well as chemotherapy-sensitive disease compared to inpatients. There were no differences in hematopoietic recovery and non-hematologic toxicities between outpatient and inpatient transplant recipients. Post-transplant febrile neutropenia and most other post-transplant toxicities were managed successfully in an ambulatory setting. Although liberal criteria were developed for hospitalization of outpatients, including clinical parameters as well as patient desire and physician/nurse judgement, only 21% of outpatients required admission after transplantation. Median hospital stay for these outpatients was 9 days, while inpatients were hospitalized for a median of 15 days (P = 0.0001). After adjusting for differences in disease and host features, our study showed outpatient management resulted in significant financial savings due to lower pharmacy (42%), hospitalization (50%) and pathology/laboratory charges (36%). We conclude that outpatient transplants should facilitate access to myeloablative therapy, thereby improving complete remission rates and survival of myeloma patients.
本报告总结了在251例连续的多发性骨髓瘤患者中进行336例自体移植手术的2年经验，这些手术是在串联移植方案中使用200mg/m²的大剂量美法仑进行的。共有91例患者作为门诊病人接受了118次移植，其余160例患者作为住院病人接受了218次移植。与住院病人相比，门诊病人通常更年轻，干细胞产品更好，血清白蛋白和β2-微球蛋白水平正常，且疾病对化疗敏感。门诊和住院移植受者在造血恢复和非血液学毒性方面没有差异。移植后发热性中性粒细胞减少症和大多数其他移植后毒性在门诊环境中得到了成功处理。尽管为门诊病人制定了宽松的住院标准，包括临床参数以及患者意愿和医生/护士的判断，但只有21%的门诊病人在移植后需要住院。这些门诊病人的中位住院时间为9天，而住院病人的中位住院时间为15天（P = 0.0001）。在调整了疾病和宿主特征的差异后，我们的研究表明，门诊管理由于药房费用降低（42%）、住院费用降低（50%）和病理/实验室费用降低（36%）而带来了显著的财务节省。我们得出结论，门诊移植应有助于获得清髓性治疗，从而提高骨髓瘤患者的完全缓解率和生存率。
