Abstract
Multiple myeloma (MM) is the most common indication for autologous stem cell transplantation (ASCT), and outpatient models have been widely developed in this setting. Although numerous studies have demonstrated the safety and feasibility of outpatient ASCT, it is not a routine procedure. Stringent guidelines for patient selection and clinical management, including functional status, caregiver support, and psychological aspects, are essential to identify eligible patients. However, there is still no general agreement on these criteria. Quality of life data are limited and contradictory. There is considerable variability in outpatient transplant models, and there are no randomised studies supporting the use of one over the other. Studies evaluating results in terms of long-term survival, transplant toxicity in comparison with a standard approach are lacking. The procedure is cost-effective within the context of a hospital budget, but an in-depth analysis of the real cost of these programmes has yet to be performed.
Highlights
Multiple myeloma (MM) is an incurable blood cancer
Findings demonstrated that outpatient autologous stem cell transplantation (ASCT) can be considered in Asia in carefully selected patients
The study confirmed the relatively low extra-haematological toxicity and the short period of post-high-dose melphalan neutropenia Younger patients and those with serum creatinine levels less than 1.5 mg/dl were more likely to complete the programme as outpatients The cost savings was $19,522 per patient (Continued)
Summary
Multiple myeloma (MM) is an incurable blood cancer. Considered as a chronic condition, it can be treated to slow its spread.In last decades, the introduction of bortezomib as first-line therapy have provided considerable improvements in treatment and prognosis of patients with MM. novel agents, including monoclonal antibodies, were recently introduced into clinical practise, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of care for eligible patients [1,2,3,4]. FN, Febrile neutropenia; EDM, early discharge model; TIA, transient ischemic attack; ECOG, Eastern Cooperative Oncology Group; DAM, delayed admission model; MIOM, mixed Inpatient-Outpatient model; TOM, total Outpatient Clinic; HCTCI, Hematopoietic Stem Cell Comorbidity Index; PFS, progression-free survival: OS, overall survival; HPC, hematopoietic progenitor cell; MEL, melphalan, BU, busulfan; SCT, Stem Cell Transplant; HM, home-care, IN, in-patient.
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