AUTOLOGOUS STEM CELL TRANSPLANTATION IN THE OUTPATIENT SETTING: FEASIBLE OR NOT?

Abstract
Hematopoietic stem cell transplantation, an increasingly popular method to treat malignancies and genetic disorders, has been traditionally performed in an in-hospital setting. Immediate complications during neutropenia (pre-engraftment period), particularly those due to infection and mucositis that need prompt care have made transplantation difficult in the outpatient setting. We retrospectively analyzed data on women undergoing autologous peripheral blood stem/progenitor cell transplantation (PBPCT) out of the hospital. There were 105 women with breast cancer receiving broad-spectrum antimicrobial prophylaxis. The conditioning regimen chosen produced minimal or no oral/gastrointestinal mucositis. All women were seen daily in the out- patient transplant clinic; appropriate medical personnel were readily available during day/night. Infectious morbidity was remarkably low with no deaths or serious adverse events. Duration of neutropenia was short (mean, 7.5 days). Fifty percent women were hospitalized usually due to persistent fever; mean duration of hospital stay was 3 days. Mucositis-sparing conditioning regimen, liberal use of colony-stimulating factors, use of broad-spectrum antimicrobial prophylaxis and importantly, ready availability of medical personnel and close daily care were the key elements for successful transplantation in the outpatient setting. Thus, autologous stem cell transplantation as an outpatient procedure is feasible. Careful clinical studies are needed of other transplant techniques (e.g. non-myeloablative technique in the allogeneic group) involving different populations in the out-of-hospital setting. If successful, transplant procedure will become economically far less expensive and importantly, patient's quality of life is likely to be significantly improved.

Key words
Transplantation, outpatient setting, antimicrobial prophylaxis.

Bibliografía del artículo

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