Outpatient Stem Cell Transplantation Research Articles

French Monocentric Experience of Outpatient Step-up Dosing of Teclistamab in Relapsed Refractory Multiple Myeloma

Background Teclistamab is the first approved BCMAxCD3 bispecific antibody for relapsed/refractory multiple myeloma and is available in France since October 2022 through a procedure facilitating patient access to innovation addressing high unmet medical needs (Acces Precoce, AP). Given specific toxicities, associated with novel bispecific therapies, including cytokine release syndrome (CRS), inpatient step-up dosing is usually considered. However, the favorable toxicity profile of teclistamab may be conducive to outpatient administration. Our center is already experienced in outpatient stem cell transplantation for newly diagnosed transplant eligible myeloma patients. Here, we report the characteristics and outcomes of patients treated with teclistamab exclusively in an outpatient setting, including the step-up dosing phase. Methods Among the 32 patients who completed the step-up dosing schedule of teclistamab in our center between January 2021 and July 2023, 15 were treated outside of clinical trials and 8 patients received teclistamab exclusively in an outpatient unit. Eligibility for outpatient step-up dose administration was based on (1) clinical and (2) logistical criteria: 1) general condition maintained, no active infection, no high tumor burden or very rapidly progressing disease; 2) patient agreeing to stay within 30 minutes of transportation to the site for 48 hours after each step-up dose and after the first full dose. The 8 eligible patients underwent specific monitoring at home: consisting of measurement of temperature, blood pressure and oxygen saturation by a homecare nurse twice a day for 15 days. Patients and careers were trained in self-monitoring of the CRS and were provided with a blood pressure monitor and an oxymeter. In addition to the regulatory documents of the French AP, patients were given a practical drug information sheet. Oral dexamethasone was available at home in case of emergency with hospital 24-hour contacts in the event of grade ≥ 2 CRS or any other complication. Results In addition to one patient treated in the MajesTEC3 trial, 7 of the 15 patients treated outside clinical trials since January 2023 (47%) were dosed exclusively in outpatient setting. Median age was 69 years (43-81). Isotype of myeloma was FLC in 5/8 patients. Teclistamab was given after a median of 4 previous lines of therapy (3-7). Dose escalation was carried out in accordance with FDA and EMA recommendations after premedication with dexamethasone. CRS was reported in 3 patients (2 grade 1, 1 grade 2 treated with dexamethasone and tocilizumab). No ICANS or infections G ≥ 2 were reported. ORR was VGPR or better in the majority of the patients (6/8). To date, only one patient required an unplanned admission, of 10 days to manage both grade 2 CRS and CMV reactivation occurred simultaneously. There were no toxicity-related deaths. According to local procedures, all the patients received prophylaxis with antibiotics and antivirals as well as polyvalent immunoglobulins. Cost analysis is ongoing and all the data will be updated at the time of the presentation. Conclusion Outpatient teclistamab step-up dose is feasible with careful patient selection and close at home monitoring, and seems associated with similar safety profiles and efficacy outcomes as inpatient treatment. Outpatient management is cost-effective and may help optimize healthcare resource utilization.

Lack of a caregiver is associated with shorter survival in myeloma patients undergoing autologous stem cell transplantation

There is increasing evidence that social infrastructure and a healthy social network can improve cancer survival. Mayo Clinic has an outpatient stem cell transplantation program for myeloma. Safe outpatient transplantation requires a caregiver to be present. Patients lacking a caregiver are transplanted as an inpatient. We reviewed outcomes on over 2000 patients with multiple myeloma, 2103 transplanted as an outpatient compared with 41 hospitalized for transplantation. Although progression-free survival following transplantation was identical between the two groups, overall survival was shorter in those hospitalized. This suggests that the absence of a caregiver for transplantation is an important surrogate of the social infrastructure associated with poor outcomes in transplanted patients with multiple myeloma

Feasibility of Outpatient Stem Cell Transplantation in Multiple Myeloma and Risk Factors Predictive of Hospital Admission.

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of care for multiple myeloma (MM) patients. Although outpatient ASCT has been shown to be safe and feasible, the procedure is overall rare with most patients in the US undergoing inpatient ASCT. Furthermore, hospitalization rates for patients that undergo outpatient ASCT remain high. Adequate markers that predict hospitalization during outpatient ASCT are lacking, yet would be of great clinical value to select patients that are suited to outpatient ASCT. In this study we aimed to elucidate differences between planned outpatient and inpatient ASCT and further evaluated clinical characteristics that are significantly associated with hospitalization during planned outpatient hospitalization. Factors that were significantly associated with a planned inpatient ASCT included an advanced MM disease stage, worse performance status as well as non-Caucasian race, while low albumin levels and female gender were significantly associated with hospitalization during outpatient ASCT. The results of this analysis provide crucial knowledge of factors that are associated with planned inpatient ASCT and hospitalization during outpatient ASCT and could guide the treating physician in decision-making and further facilitate outpatient transplantation.

Feasibility of Outpatient Autologous Stem Cell Transplantation in Multiple Myeloma and Risk Factors Predicting Hospital Admission

Introduction- High dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) remains the standard treatment for multiple myeloma (MM) for eligible patients. While ASCT in most centers is performed on an inpatient basis, we and others have shown its feasibility in an outpatient setting. Due to improved supportive care, enhanced patient and caregiver education and preference, the majority of MM patients at our center will initiate outpatient ASCT. However, a part of these patients will require hospital admission pre-emptively due to co-morbid conditions or related to therapy-associated toxicity. To elucidate clinical characteristics and markers predicting for hospital admission in an ambulatory setting, we investigated a total of 1446 MM patients receiving ASCT at UAMS from 2015-2019. Methods- Of the 1446 MM patients, 550 initiated their ASCT as inpatients, 280 started as outpatients but required subsequent hospital admission and 616 completed ASCT in an ambulatory setting. The decision to initiate ASCT as in- or outpatient was based on clinical and social factors. In most cases, Pptients received high dose Melphalan conditioning (74%) followed by dose-reduced Melphalan in combination with Cisplatin, Adriamycin, Cyclophosphamide and Etoposide (PACE, 15%) and BEAM conditioning (9.2%). For comparison between the transplant groups, we used analysis of variance (for continuous-like variables) and Pearson's chi-squared test (for categorical variables). Multivariable logistic regression model was used to examine the combined effects of various clinical variables on the probability of hospitalization after receiving an outpatient autologous transplant. Results- 62% (896/1446) of all patients initiated ASCT on an outpatient basis. Of those, 31% (280/896) required hospital admission within 15 days post-transplant. Main reasons for hospital admission were neutropenic fever (45%), intractable nausea/diarrhea/poor oral intake (29%, n=81/280) followed by more uncommon events such as cardiac problems (6%) and MM related pain (4%, n=12/280) and 16% other reasons (45/280). Median day of admission was D+7 after ASCT (range: D+1 to D+15) with a median length of stay of 8 days (range: 2-49 days). Median age of patients who completed outpatient ASCT (60.4 years) was significantly lower (p<0.001) than of those who required admission (62.9 years) or initiated ASCT as inpatients (61.6 years). Patients initiating ASCT as inpatients had significantly lower Karnosfsky score, albumin and DLCO but higher b2-microglobulin and creatinine compared to those who completed ASCT as outpatients and those requiring admission (all p<0.001). There was no significant difference in day of ANC nadir or engraftment, number of previous ASCTs, body mass index or conditioning regimen between these groups. To predict the need for admission in patients who initiated ASCT in an ambulatory setting, we investigated various clinical markers, including performance status, age, creatinine, b2-microglobulin and lung function tests, and showed that in a multivariant model only advanced age (p=0.02) and reduced albumin (p<0.01) were significant prognostic factors for hospital admission. Thirty day mortality was low in all transplant groups, yet patients who completed their ASCT on an ambulatory setting had significant less 30 day mortality (0.1%, n=1/616) compared to those that underwent inpatient ASCT (1.6%, n=9/550) and those that required admission after ASCT initiation in an outpatient setting (1.4%), p=0.03. Conclusion- Outpatient stem cell transplantation can be safely performed in the large majority of patients with good performance status and organ function. Advanced age and reduced albumin levels predict for a significantly higher likelihood of inpatient admission. These factors could help guiding physicians to better identify patients at high risk for admission during outpatient ASCT. Disclosures van Rhee: Takeda: Consultancy; Adaptive Biotech: Consultancy; CDCN: Consultancy; EUSA: Consultancy; Karyopharm: Consultancy.

Feasibility of and Decreased Inpatient Hospital Days for Non-Hodgkin Lymphoma (NHL) and Hodgkin Lymphoma (HL) Patients with Outpatient BEAM Using Daily Etoposide and Cytarabine and Autologous Hematopoietic Stem Cell Transplantation (AHCT)

<h3>Introduction</h3> BEAM is a commonly used AHCT regimen for NHL and HL. The twice daily dosing of etoposide and cytarabine requires inpatient hospitalization, and pts remain inpatient until neutrophil recovery. We aimed to evaluate the feasibility and safety of outpatient BEAM with AHCT using daily etoposide and cytarabine. <h3>Methods</h3> We performed a retrospective analysis of patients treated with BEAM and AHCT in the outpatient transplant setting at Memorial Sloan Kettering Cancer Center from October 2018 to August 2019. Carmustine was given on day -6 (300mg/m2), etoposide (200mg/m2/dose) and cytarabine (400mg/m2/dose) daily from day -5 through day -2, and melphalan on day -1 (140mg/m2). Stem cell infusion and supportive care were performed per standard of care and institutional guidelines, including a delayed emesis prophylactic regimen of from D+1 to +7 after the first three pts. Packed red blood cells were given for hemoglobin <7g/dl and platelets for platelet counts <20K/mcl. <h3>Results</h3> For 18 pts, the median age was 38 (range 24-21) with 72% male. Lymphoma subtypes are shown in Figure 1. Median dose of CD 34+ cells infused was 6 × 10^6 CD34+cells/kg (range: 2.54-10.66). Cell infusions were given over 2 days in 3 pts. Washed cell infusions were administered to 6 pts. Median melphalan AUC was 6.2 (range 3.5-14, Figure 3). Median days to neutrophil engraftment was 9 (range: 8-12). Median number of platelet transfusions per pt was 4 (range: 2-8). Median packed red blood cells per pt was 1 (range: 0-6). Median number of days of grade2+ diarrhea was 3 (range: 0-11). Four pts (22%) required additional antiemetics outside the standard of care. Median weight lost per pt was 2.8kg (range: 0-10.3kg). Median number of intravenous fluid boluses was 5.5 (range: 1-10). Pts maintained a mean serum creatinine of 0.9mg/dl (range:0.7-1.5mg/dl). Engraftment syndrome was diagnosed in 44%. All patients were alive as of 9/30/19 with median follow-up of 62 days (range: 34-291). A total of 236 hospital days were saved using the outpatient regimen. Median number of hospital days saved per pt was 13. Fifteen pts required admission during the transplant course while 3 completed the transplant entirely outpt. Median day of hospital admission was +6 (range: +1 to +11). Reasons for admission are shown in Figure 2. Median number of inpt hospital days was 4 (range: 3-14). Ten pts returned to the outpatient stem cell transplant clinic for management prior to day 30. One pt was re-hospitalized prior to day 30. <h3>Conclusion</h3> BEAM using daily dosed etoposide and cytarabine with AHCT was not only feasible and safe for the outpatient setting, but also has the potential to reduce inpatient hospital days.

Outpatient BEAM Using Daily Etoposide and Cytarabine with Autologous Hematopoietic Stem Cell Transplantation for Lymphoma Is Feasible and Decreases Inpatient Length of Stay

Introduction: High dose therapy with carmustine, etoposide, cytarabine, and melphalan (BEAM) followed by autologous hematopoietic stem cell transplantation (AHCT) is the most common consolidation therapy for chemosensitive patients with relapsed/refractory Non-Hodgkin Lymphoma (NHL) and Hodgkin Lymphoma (HL) in the US. Inpatient hospitalization is usually required due to the twice daily dosing of etoposide and cytarabine, and patients remain admitted until neutrophil recovery. Utilizing our outpatient transplant program, we aimed to evaluate the feasibility and safety of outpatient BEAM with AHCT using daily dosed etoposide and cytarabine to enhance the patient experience and improve inpatient resource utilization. Methods: We performed a retrospective evaluation of patients treated in the outpatient setting at Memorial Sloan Kettering Cancer Center. Patients were eligible for outpatient AHCT if they did not have a clinical indication for inpatient continuous monitoring. Patients received BEAM conditioning consisting of carmustine on day -6 (300mg/m2), etoposide daily from day -5 through day -2 (200mg/m2/dose), cytarabine daily from day -5 through day -2 (400mg/m2/dose), and melphalan on day -1 (140mg/m2). AHCT on day 0, pegfilgrastim on Day +1, and supportive care were performed as per standard of care and institutional guidelines. Patients were seen daily by an advanced practice provider and HCT attending. Notably, service guidelines were revised to include a delayed emesis prophylactic regimen of oral dexamethasone (2mg bid) and lorazepam (0.5mg TID) from D+1 through D+7, which was initiated after the first three patients were treated. Patients were transfused packed red blood cells (pRBC) for hemoglobin &lt;7g/dl and platelets for &lt;20K/mcl. Results: From October 2018 to July of 2019, 13 patients (Hodgkin's lymphoma (n=5), mantle cell lymphoma (n=4), diffuse large B-cell lymphoma (n=2), T-cell lymphoma (n=2), and grey zone lymphoma (n=1)) were treated. The median age was 40 years (range 26-71), and the majority were male (69%). Median cell dose infused was 5.89 CD34+ cells/kg (range 2.53-10.66). Two patients received cell infusions over 2 days, and three patients received washed cell infusion products. Two patients completed transplant entirely outpatient; the remainder required hospitalization during their transplant course. Reasons for admission included neutropenic fever (n=4), nausea (n=2), tachycardia (n=2), hypoxia (n=1), and other (n=2). Patients were admitted on a median of Day +6 (range Day+1 - Day+11) and remained inpatient for a median of 4 days (range 3-14). Eight patients (62%) returned to the outpatient stem cell transplant clinic for management prior to day 30. One patient was re-hospitalized prior to day 30. The median number of hospital days saved was 13 days/per patient. In total, 170 hospital days were saved with this regimen. Engraftment and toxicities were similar to inpatient administration. Neutrophil engraftment occurred at a median of Day+9 (range 8-11) with a median of 6 days of ANC&lt;500 (IQR 8-11). Platelets comprised most of the transfusion support required, with a median of 4 platelet (range 2-8) and 2 pRBC (range 0-2) transfusions per patient. Grade 2 or higher diarrhea occurred for a median of 3.5 days (range 3-11) with 38% not having any diarrhea. A small percentage of patients required additional antiemetics outside the standard of care (23%). The median weight lost per patient was 2.5kg (range 0 - 10.3kg). Patients received intravenous fluid support with a median of 5 normal saline boluses (range 1-10). All patients maintained normal serum creatinine peri-transplant, with a median maximum serum creatinine of 0.9mg/dl (range 0.7-1.1). Six patients (46%) had engraftment syndrome. All patients were alive with a median follow-up of 91 days (range: 29-205). Conclusion: We found that BEAM followed by AHCT using daily dosed etoposide and cytarabine is feasible and safe for the outpatient setting with tolerability matching that of the traditional inpatient BEAM regimen. Moreover, this treatment method has the potential to reduce a considerable number of inpatient hospital days, while still safely maintaining a threshold for toxicity requiring inpatient admission. Disclosures Bhatt: Incyte: Consultancy. Landau:Pfizer: Membership on an entity's Board of Directors or advisory committees; Caelum: Membership on an entity's Board of Directors or advisory committees; Prothena: Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Consultancy, Honoraria. Scordo:Angiocrine Bioscience, Inc.: Consultancy; McKinsey &amp; Company: Consultancy. Sauter:Juno Therapeutics: Consultancy, Research Funding; Kite/Gilead: Consultancy; Precision Biosciences: Consultancy; Genmab: Consultancy; Spectrum Pharmaceuticals: Consultancy; GSK: Consultancy; Celgene: Consultancy; Novartis: Consultancy; Sanofi-Genzyme: Consultancy, Research Funding. Giralt:Celgene: Consultancy, Research Funding; Takeda: Consultancy; Sanofi: Consultancy, Research Funding; Amgen: Consultancy, Research Funding. Shah:Amgen: Research Funding; Janssen: Research Funding.

Outpatient Stem Cell Transplantation Using a Reduced-Intensity Conditioning in Type 1 Diabetes Mellitus

Outpatient Stem Cell Transplantation Using a Reduced-Intensity Conditioning in Type 1 Diabetes Mellitus

Adherence of stem cell transplant recipients receiving glucocorticoid therapy to an exercise-based rehabilitation program

The high acuity of hematopoietic stem cell transplant (HSCT) recipients receiving glucocorticoid (GC) therapy for acute graft vs. host disease (aGVHD) may limit their adherence to an exercise-based rehabilitation program and hence, slow their recovery. To make this determination, the medical records of 59 subacute outpatient stem cell transplant recipients receiving methylprednisolone (MP) were reviewed for demographic, anthropometric and medical information. Performance on the repeated sit-to-stand, 50-ft walk and 6-min walk tests were determined before and after completing a 4-week progressive exercise rehabilitation program and outcomes were compared by a paired t-test (P < 0.05). Thirty-two patients (54%) finished a treatment plan (adherent group), completing 80% of the prescribed sessions and were reevaluated. Twenty-seven patients (46%) did not complete the rehabilitation program (nonadherent group), primarily because of readmission to the hospital (18 patients, 62%). The adherent group did not significantly improve their physical performance (p > 0.05). However, a subgroup of 40% of these patients did experience clinically significant improvements in their physical performance.These findings 1) support the feasibility of having HSCT recipients receiving GC therapy to participate in an exercise-based rehabilitation program and 2) suggest that to do so can result in clinically significant improvements in functional capacity.

Outpatient versus inpatient autologous stem cell transplantation for malignant hematologic disorders

7042 Background: High-dose chemotherapy with autologous stem cell support is utilized for the treatment of a variety of malignancies including Hodgkin/non-Hodgkins lymphoma and acute leukemias. The aim of this study was to compare the time of engraftment and mortality rate and cost of neutropenic treatment in outpatient versus inpatient autologous stem cell transplantation (SCT). Methods: 9 outpatients (5 HL, 2 NHL, and 2 AML) were compared with 32 inpatients (15 HL, 8 NHL, and 9 AML; for whom the outpatient facilities were not ready) from May 2008 to December 2008. All patients were below 45 yrs; median age for outpatients and inpatients were 26 and 30 years respectively. Also all the patients were in complete remission and without significant organ failure. They received conditioning regimen (CEAM for NHL and HL, busulfan and etoposide for AML) and stem cell infusion in hospital. The day after SCT, outpatient group were discharged and followed by outpatient SCT team, and to be re-hospitalized in case of febrile neutropenia, after sepsis workup and performing chest x-ray, they were received the first dose of antibiotic in hospital and treatment continued in home. Results: For outpatients and inpatients, median time to WBC engraftment was 11 and 12 days (p = 0.03), time to PLT engraftment was 15 and 25 days (p = 0.20), number of transfused single donor PLT was 3 and 4.5 units (p = 0.21), duration of neutropenic fever was 6 and 9 days (p = 0.001), duration of hospitalization (after SCT) 0 and 16 (p &lt; 0.001), respectively. All outpatients are alive and 3 patients from other group died between days +35 and +100 after SCT due to transplantation complications. For inpatient group the cost of drugs, just for neutropenic fever antibiotic therapy was six times than outpatient group. Conclusions: Results show that out-patient autologous SCT in malignant hematologic disorders is feasible and comparable with inpatient protocol. We are waiting for more patients and longer follow-up for future conclusions. No significant financial relationships to disclose.

Clinical Pathways and Standard Operating Procedures: Essential Tools for Outpatient Stem Cell Transplant Programs Treating Patients With AL Amyloidosis

Clinical pathways (CPs) and standard operating procedures (SOPs) are necessary for treating AL patients with high-dose melphalan and stem cell transplantation (HDM/SCT) in the outpatient setting. AL is a plasma cell dyscrasia in which abnormal proteins misfold, form fibrils and deposit in vital organs causing malfunction and death. HDM/SCT can produce hematologic remissions and prolong survival. HDM/SCT was developed for the treatment of AL at Boston University Medical Center in 1994. In 1996, treatment was moved to the outpatient setting.

A Multidisciplinary Quality Initiative for Stem Cell Transplantation in Multiple Myeloma: Outpatient Transplant with Low Therapy Related Mortality

Introduction: The Bone Marrow Transplant Program at Mayo Clinic (Rochester, Minnesota) developed a multidisciplinary approach (involving physicians, nurses, pharmacists, dietitians, and financial specialists) for outpatient management of patients undergoing stem cell transplantation. This approach uses an electronic ordering system for diagnostic tests and chemotherapy to minimize medical errors.Table. Patient Characteristics (N=716)CharacteristicValueMale, no. of patients (%)426 (59)Age, median (IQR), y59 (53–65)Creatinine, median (IQR), mg/dL1.0 (0.9–1.2)b2-Microglobulin, median (IQR), mcg/mL2.5 (1.9–3.7)Gammopathies, no. of patients (%)Measured by serum immunofixation or immunoelectrophoresisIgA148 (21)IgG414 (58)IgM6 (1)IgD12 (2)Light chain83 (12)Biclonal6 (1)None47 (7)Measured by urine immunofixation or immunoelectrophoresisk light chain402 (56)l light chain226 (32)Biclonal1 (0)None79 (11)Not performed (anuric)8 (1)Status at stem cell transplant, no. of patients (%)Untreated4 (1)Plateau436 (61)Primary refractory113 (16)Relapse after therapy93 (13)Relapse during therapy70 (10)CharacteristicValueCD34+ cells, median (IQR), ×106/kgCollected, no.10.0 (7.6–12.6)Infused, no.4.7 (3.9–6.2)Sessions of apheresis, median (IQR)3 (2–5)Engraftment, median (IQR), days after transplantationNeutrophils, 0.5×109/L13 (12–15)Platelets, 50×109/L16 (14–22)Duration of hospitalization, median (IQR), d4 (0–10)Abbreviation: IQR, interquartile range.Results: During a 45-month period after implementation of the program (2005-Sept 2007), the day-100 survival rate was 99.5% for low-risk myeloma patients (transplantation during first plateau; n=202) and 97% for high-risk myeloma patients (refractory, relapsing or second or greater plateau; n=71). The overall day-100 survival rate was 99%(270/273). Analysis of hospitalization trends since inception of the program showed that 39% of patients completed the transplant procedure as outpatients. The median duration of hospitalization for all patients was 4 days; age and serum creatinine levels were predictive of the need for and duration of hospitalizationConclusion: Outpatient stem cell transplantation is feasible for patients with multiple myeloma with a therapy mortality of 1%. Nearly 40% of our patients completed the procedure without hospitalization. Age and serum creatinine levels predicted a higher likelihood of hospitalization. Implementation of out patient transplant requires affordable housing in the community since many third party payers do not support hotel costs despite the reduction of hospital days. The hospital physical plant and patient registration process has to support use of designated hospital rooms for purely out patient practice. The transplant team must have process owners to standardize across all disease categories collection protocols, conditioning regimens, infusion SOP's and post infusion supportive care guidelines for standard antibiotics, narcotics, laboratory work and transfusion thresholds. A care team meeting between physicians, nursing, dietary, pharmacy, business office, data base and appointment coordinators is essential to coordinate all the multidisciplinary efforts. [Display omitted] [Display omitted]

Outpatient stem cell transplant: effectiveness and implications

The aim of this mini-review (Griffiths, 2002) was to assess whether outpatient autologous haematopoietic stem cell transplant (AHSCT) is as effective as the traditional inpatient approach in terms of bed occupancy and morbidity. The Cochrane Library, Medline, Embase and CINAHL databases were searched for relevant studies. No systematic reviews or randomized control trials were found and after applying inclusion criteria, four non-randomized control trials were identified. The studies were conducted in North America, where high costs associated with AHSCT have led to the development of outpatient programmes designed specifically to reduce use of costly inpatient facilities. From the evidence available, it appears that outpatient AHSCT is not associated with increased morbidity and studies found either in favour of the intervention group or that there was no statistically significant difference between the two groups. The studies were unanimous in their findings that outpatient AHSCT is associated with a significantly reduced bed occupancy outcome. These findings may have a significant implication for the advancing practice and workload of community nurses. It is evident that good quality trials are needed in the UK to better and more relevantly address this question before implementing such programmes but it seems that outpatient AHSCT is achievable in carefully selected patients.

A retrospective analysis of hospital admissions in an outpatient stem cell transplant facility

A retrospective analysis of hospital admissions in an outpatient stem cell transplant facility