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Outpatient Autologous Stem Cell Transplant

Jane Koo, Stacy Silverman, Brandon Nuechterlein, Amy K Keating, Michael R Verneris, Nicholas K Foreman, Jean M Mulcahy Levy
High-dose chemotherapy with autologous hematopoietic stem cell transplantation (autoHSCT) is a well-established treatment for pediatric central nervous system (CNS) tumors. Given the risks of toxicity and infection, pediatric autoHSCT has been historically performed on hospitalized children. As our practice evolved, some patients were transplanted as outpatients. We performed a retrospective cohort analysis of 37 patients who received 90 transplant procedures (49 outpatient and 41 inpatient) at Children's Hospital Colorado...
February 19, 2019: Bone Marrow Transplantation
Mark Paul, Najihah Hanim Asmi, Eshamsol Kamar Omar, Suhaila Abdullah, Irfan Mohamad
Mantle cell lymphoma (MCL) is a rare, aggressive subtype of non-Hodgkin lymphoma with a poor prognosis and high recurrence rate. It seldom affects the Waldeyer's ring let alone the nasopharynx. Patients usually present at late stages of the disease leading to poor failure-free and overall survival rates. Intensive chemotherapy regimes and autologous stem cell transplantation have reported increased survival rates. We report a relapsed case of nasopharyngeal MCL, which previously occurred in the gastrointestinal tract...
January 2019: Oman Medical Journal
Rachel Russo, Elisa Teixeira Mendes, Anna Sara Levin, Frederico Dulley, Maura S Oliveira, Maria Aparecida Shikanai-Yasuda, Silvia Figueiredo Costa
We described 235 bloodstream infection (BSI) episodes in 146 hematopoietic stem cell transplantation (HSCT) outpatients and evaluated risk factors for hospitalization and death. Records of outpatients presenting with positive blood cultures over a 5-year period (January 2005 to December 2008) were reviewed. Variables with p< 0.1 in bivariate analysis were used in a regression logistic model. A total of 266 agents were identified, being 175 (66.7%) gram-negative, 80 (30.3%) gram-positive bacteria and 9 (3...
December 20, 2018: Revista do Instituto de Medicina Tropical de São Paulo
Weerapat Owattanapanich, Kittima Suphadirekkul, Chutima Kunacheewa, Patompong Ungprasert, Kannadit Prayongratana
BACKGROUND: Outpatient autologous stem cell transplantations (ASCTs) in multiple myeloma and lymphoma patients have been shown to reduce the overall costs and improve the quality of life relative to inpatient ASCTs. This systematic review and meta-analysis was performed with the aim of comprehensively comparing the risk of febrile neutropenia developing in ASCT outpatients and inpatients who have multiple myeloma or lymphoma. METHODS: To be eligible for the meta-analysis, studies needed to be either randomized, controlled studies or cohort studies...
November 16, 2018: BMC Cancer
José Carlos Jaime-Pérez, Lorena Salazar-Cavazos, Patrizia Aguilar-Calderón, José Luis Herrera-Garza, César Homero Gutiérrez-Aguirre, David Gómez-Almaguer
Efficacy of an ambulatory hematopoietic stem cell transplant (HSCT) program with a reduced intensity conditioning regimen (RIC) in malignant hematological diseases was assessed. We analyzed 217 patients who underwent HSCT from August 2013 to July 2017. There were 78 (35.9%) HLA-identical, 56 (25.8%) haploidentical, and 83 (38.2%) autologous transplants. Two-year transplant-related mortality (TRM) for HLA-identical, haploidentical, and auto grafts were 20%, 25%, and 2.5%; relapse/progression was 44%, 60%, and 55%; overall survival (OS) was 61%, 44...
September 21, 2018: Bone Marrow Transplantation
Alok Kumar Sahoo, Savita Yadav, Vinod K Sharma, Anita Singh Parihar, Surabhi Vyas, Somesh Gupta
Background: Available options for correction of facial volume loss, such as synthetic fillers, autologous fat and cultured fibroblasts, have limitations viz. temporary effect and high cost. Aim: To assess the use of a novel technique, autologous non-cultured dermal cell suspension transplantation, for correction of localized facial volume loss due to inflammatory pathologies. Methods: It was a pilot study conducted in the Dermatology Outpatient Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India...
July 30, 2018: Indian Journal of Dermatology, Venereology and Leprology
Michael T Brennan, Bengt Hasséus, Allan J Hovan, Judith E Raber-Durlacher, Nicole Ma Blijlevens, Marie-Charlotte Huysmans, Karin Garming Legert, Jan-Erik Johansson, Charity G Moore, Inger von Bültzingslöwen
BACKGROUND: The oral cavity is a common site of complications related to the cytotoxic effect of high-dose chemotherapy and radiation therapy. Considering our limited understanding of the burden of illness in the oral cavity from various cytotoxic therapies, it is difficult to produce evidence-based, preventive and management protocols. A prospective multicenter study is necessary to collect data on the burden of illness from various cytotoxic regimens. OBJECTIVE: The objectives of this prospective international observational multicenter study in hematopoietic stem cell transplant (HSCT) patients are to establish the nature, incidence and temporal relationship of oral complications related to conditioning regimens (chemotherapy with or without total body irradiation), stem cell transplantation and the immunologic reactions (mainly graft-vs-host-disease) that may follow, and to determine what subjective and objective oral complications related to treatment can predict negative clinical and economic outcomes and reduced quality of life...
April 23, 2018: JMIR Research Protocols
Takashi Kanamori, Shigeru Kusumoto, Kenji Okita, Shinya Hagiwara, Chie Kato, Takahiro Nakashima, Satsuki Murakami, Tomoko Narita, Asahi Ito, Masaki Ri, Takashi Ishida, Hirokazu Komatsu, Noriyuki Matsukawa, Shinsuke Iida
A 40-year-old female presented with a skin rash, hepatosplenomegaly, hypothyroidism, IgG-λ monoclonal gammopathy, slightly elevated serum VEGF levels, and >1-year history of weakness in the posterior cervical muscles. Based on these symptoms and her clinical course, she was suspected of having POEMS syndrome. However, because there was no sign of peripheral neuropathy (PN), the criteria for the diagnosis of POEMS syndrome were not met. Consequently, she continued follow-up and was under close observation as an outpatient...
2018: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Noa Lavi, Irit Avivi, Zipora Kra-Oz, Ilana Oren, Emilia Hardak
PURPOSE: Available data suggest that respiratory infections are associated with increased morbidity and mortality in patients hospitalized due to acute leukemia and allogeneic stem cell transplantation (allo-SCT). However, the precise incidence, risk factors, and severity of respiratory infection, mainly community-acquired, in patients with lymphoma and multiple myeloma (MM) are not fully determined. The current study aimed to investigate risk factors for respiratory infections and their clinical significance in patients with B cell non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) in the first year of diagnosis...
July 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Mustafa A Hyder, W Scott Goebel, Kirsten D Ervin, Jennifer E Schwartz, Michael J Robertson, Teresa C Thakrar, Costantine Albany, Sherif S Farag
Tandem autologous stem cell transplantation (ASCT) improves long-term survival of platinum-refractory germ cell tumors (GCT) patients. Studies, predominantly in lymphoma, showed that CD34+ cell doses > 5.0 × 106 /kg/single transplant led to decreased resource utilization. Because most GCT patients have received prior cisplatin-based treatment, collecting >10 × 106 CD34+ cells/kg is challenging. We analyzed the effect of CD34+  cell dose on resource utilization and outcome in 131 GCT patients, median age 29...
July 2018: Biology of Blood and Marrow Transplantation
Gunjeet Kaur, Shankar Prinja, Pankaj Malhotra, Deepesh P Lad, Gaurav Prakash, Alka Khadwal, Raja Ramachandran, Subhash Varma
Multiple myeloma (MM) is a neoplastic disorder, which accounts for 13% of all hematological malignancies globally. While, conventional chemotherapy used to be the mainstay treatment for the disease, the landscape of treatment witnessed a paradigm shift with the introduction of high-dose chemotherapy and autologous stem cell transplant (ASCT). In this paper, we present a cost analysis of various services provided to multiple myeloma patients, using either of the two modalities of treatments i.e. conventional chemotherapy or ASCT...
January 2018: Indian Journal of Hematology & Blood Transfusion
Muhammed Razmi T, Ravinder Kumar, Seema Rani, Sendhil M Kumaran, Sushma Tanwar, Davinder Parsad
Importance: Epidermal cell suspension (ECS) and follicular cell suspension (FCS) are successful surgical modalities for the treatment of stable vitiligo. However, repigmentation in generalized and acrofacial vitiligo and over acral or bony sites (eg, elbows, knees, iliac crests, and malleoli), which are difficult to treat, is challenging. Objective: To study the efficacy of transplanting a combination of autologous, noncultured ECS and FCS (ECS + FCS) compared with ECS alone in stable vitiligo...
March 1, 2018: JAMA Dermatology
Morie A Gertz, Francis K Buadi, Suzanne R Hayman, Martha Q Lacy, Angela Dispenzieri, David Dingli, Wilson I Gonsalves, Shaji Kumar, Prashant Kapoor, Taxiarchis Kourelis, William J Hogan
Systems have been put in place in the Mayo Clinic Stem Cell Transplantation program to reduce day-100 all-cause mortality. Currently our mortality has been reduced to 0.3%. Patients can undergo transplant as an outpatient, with a median hospital duration of 0 days and only 25% of patients requiring a hospital stay of 5 days or greater. Outpatient transplantation is safe and reduces patient-incurred costs.
January 2018: Mayo Clinic Proceedings
Ahna L H Pai, Joseph Rausch, Sarah Drake, Caroline F Morrison, Jennifer L Lee, Adam Nelson, Alayna Tackett, Suzanne Berger, Lauren Szulczewski, Constance Mara, Stella Davies
We prospectively examined rates of outpatient oral medication adherence in children after hematopoietic stem cell transplant (post-HSCT). For 6 months after first discharge post-HSCT, 50 patients (aged 0 to 16 years) and their primary caregivers agreed to store 1 oral medication in an electronic pill bottle that date and time stamps each bottle opening. Demographics, disease, donor type, and prescribed post-HSCT medication regimen were collected via chart review. For each patient percent adherence was calculated by dividing the number of doses taken as indicated by the electronic pill bottle by the number of doses prescribed for the same time period...
February 2018: Biology of Blood and Marrow Transplantation
Massimo Martino, Sabino Ciavarella, Simona De Summa, Letteria Russo, Nicola Meliambro, Lucrezia Imbalzano, Giuseppe Alberto Gallo, Tiziana Moscato, Giuseppe Messina, Anna Ferreri, Maria Cuzzola, Giuseppe Irrera, Virginia Naso, Michele Cimminiello, Giuseppe Console, Giacomo Loseto, Stefania Tommasi, Attilio Guarini
Outpatient autologous stem cell transplantation (ASCT) has proven to be feasible in terms of physical morbidity and mortality outcomes, but little data exist on the impact of this procedure on quality of life (QoL). The purpose of this prospective, observational, longitudinal cohort study was to compare the effects of inpatient (n = 76) and outpatient (n = 64) modes of care on QoL in patients with multiple myeloma who underwent ASCT. Patients were treated according to their preference for the inpatient or outpatient model...
March 2018: Biology of Blood and Marrow Transplantation
Jack Khouri, Navneet S Majhail
PURPOSE OF REVIEW: Autologous stem cell transplantation (ASCT) is generally performed in the inpatient setting in its entirety. Several centers have demonstrated the feasibility of performing ASCT for myeloma in the ambulatory setting. We review the safety, cost-effectiveness, complications and outcomes of outpatient ASCT for myeloma. RECENT FINDINGS: Published studies are heterogeneous but suggest that outpatient ASCT for myeloma is cost-effective and associated with a shorter or no initial hospitalization, albeit there is a high rate of readmission for complications...
December 2017: Current Opinion in Supportive and Palliative Care
Massimo Martino, Giuseppe Console, Letteria Russo, Antonella Meliado', Nicola Meliambro, Tiziana Moscato, Giuseppe Irrera, Giuseppe Messina, Antonella Pontari, Fortunato Morabito
BACKGROUND: Activity-based costing (ABC) was developed and advocated as a means of overcoming the systematic distortions of traditional cost accounting. MATERIALS AND METHODS: We calculated the cost of high-dose chemotherapy and autologous stem cell transplantation (ASCT) in patients with multiple myeloma using the ABC method, through 2 different care models: the total inpatient model (TIM) and the early-discharge outpatient model (EDOM) and compared this with the approved diagnosis related-groups (DRG) Italian tariffs...
August 2017: Clinical Lymphoma, Myeloma & Leukemia
Monica M Rivera-Franco, Eucario Leon-Rodriguez, Haydee L Castro-Saldaña
Costs of HSCT in the United States have been widely reported, but complete information on costs in developing countries is lacking. We performed an analysis designed to assess the real, detailed costs of HSCT in Mexico. Using the database of the Current Accounts Department at our Institution, we performed a micro-costing based analysis of patients from 2010 through 2015 to obtain the overall cost of HSCT during the in-patient procedure and 2-month follow-up. One hundred five transplantations (57% autologous) were performed...
October 2017: International Journal of Hematology
Thomas E Witzig, Patrick B Johnston, Betsy R LaPlant, Paul J Kurtin, Levi D Pederson, Dennis F Moore, Nassim H Nabbout, Daniel A Nikcevich, Kendrith M Rowland, Axel Grothey
Patients with relapsed aggressive non-Hodgkin lymphoma (NHL) are often treated with platinum-based chemoimmunotherapy regimens in preparation for autologous stem cell transplant. We sought to reduce toxicity and maintain efficacy by using oxaliplatin with rituximab, cytarabine and dexamethasone (ROAD) in a phase II clinical trial in patients who had relapsed after one prior regimen. ROAD was delivered q21 days and consisted of rituximab 375 mg/m2 IV weekly x 4 doses (cycle 1 only); dexamethasone 40 mg PO/IV d2 - 5; oxaliplatin 130 mg/m2 IV day 2; cytarabine 2000 mg/m2 IV × two doses on days 2 to 3; and pegfilgrastim 6 mg SC on day 4...
October 2017: American Journal of Hematology
Cynthia Obiozor, Dipti P Subramaniam, Clint Divine, Leyla Shune, Anurag K Singh, Tara L Lin, Sunil Abhyankar, G John Chen, Joseph McGuirk, Siddhartha Ganguly
Although outpatient autologous stem cell transplantation (ASCT) is safe and feasible in most instances, some patients undergoing planned outpatient transplantation for multiple myeloma (MM) will need inpatient admission for transplantation-related complications. We aim to evaluate the difference, if any, between outpatient and inpatient ASCT cohorts of MM patients in terms of admission rate, transplantation outcome, and overall survival. We also plan to assess whether the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and Karnofsky Performance Status (KPS) can predict unplanned admissions after adjusting for confounding factors...
October 2017: Biology of Blood and Marrow Transplantation
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