Outpatient Autologous Stem Cell Transplantation for Patients With Myeloma

High-dose melphalan with autologous stem cell transplantation is a standard component of multiple myeloma treatment typically requiring an extended hospital stay. This study reviews our experience selecting patients for a brief hospitalization followed by outpatient follow-up. Of 301 melphalan transplants for myeloma at our center during the study period, 82 (27%) were done as an outpatient. Our institutional experience indicates that, in selected patients, a strategy of outpatient management does not result in increased complications. Background: High-dose melphalan with autologous stem cell support improves survival for patients with myeloma. For selected patients, we have been using a protocol of short hospitalization, discharging patients to home with careful outpatient monitoring in the office, which we hypothesized would reduce complications and utilization of inpatient beds. Methods: We reviewed 301 initial autologous transplants for myeloma, categorized as brief stay (<= 4 days, 82 patients) or prolonged stay (>= 5 days, 219 patients). Selection for a brief stay was determined by clinical characteristics, availability of caregivers at home, distance from our medical center, and patient preference. Results: Within the brief stay population, 67% required readmission before day + 100, but this group still had fewer cumulative hospital days (9 vs. 18, P < .0001). There were fewer documented infections among brief stay patients (22% vs. 46% P < .001) and fewer admissions to intensive care units (0% vs. 5.9%, P = .02). The groups had similar rates of bleeding (1.2% vs. 1.4% P = 1.0) and thrombosis (3.7% vs. 4.6% P = 1.0). No patients in the brief stay group died within 100 days, compared with mortality of 1.8% (P = .6) in the prolonged stay group. Conclusion: Carefully selected patients receiving an autologous stem cell transplant for treatment of myeloma can be managed with a brief initial hospitalization and outpatient follow-up, with low morbidity and mortality.