At-home management of aplastic phase following high-dose melphalan with stem cell rescue for multiple myeloma patients.

Abstract

e18577 Background: After high-dose chemotherapy with autologous stem-cell support, long hospital stays in the aplastic phase are expensive, lead to increased risk of hospital infections and to increasing pressure on available hospital beds. Methods: We developed a home care regimen that allows patients to be at home for the aplastic period, without daily hospital visits. Between June 2010 and December 2010, transfer of supportive care to the home setting took place was proposed for 20 patients with multiple myeloma and treated with melphalan 200 mg/mq and autologous stem-cell transplant. 12 patients refused and 8 have accepted the program, respectively. Results: In the inpatient cohort, the supportive care designed for at home use was administered in the hospital until neutrophile recovery to 0.5 x 109/l. In the second, home care cohort consisted of patients who were discharged the day after stem cell reinfusion, after which specialized home care nurses delivered all supportive care including transfusions and parenteral antibiotics at home, with double day check-up in home by the transplant physician. Inpatients were hospitalized in the aplastic phase for a median of 14 days. Patients in the home care cohort were at home in the aplastic phase for a median of 12 days. No readmissions in hospital related to side effects was observed in home care cohorts. No infectious deaths or unexpected emergencies occurred in the home care cohort. Neither was there any suggestion of an increased number of fevers, infections, or other complications. Conclusions: At home management in the aplastic phase after high-dose melphalan and stem cell transplant by community-based professionals is feasible without signs of increased toxicity or infections.