Allogeneic stem cell transplantation with reduced-intensity conditioning is potentially feasible as an outpatient procedure

• Published in: Bone marrow transplantation (Basingstoke) Vol. 32; no. 9; pp. 869 - 872
• Main Authors: SUBIRA, M, SUREDA, A, ANCIN, I, MARTINO, R, ALTES, A, BRUNET, S, SIERRA, J
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.11.2003
• Subjects: Adult; Ambulatory Care; Ambulatory medical care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - toxicity; Biological and medical sciences; Blood diseases; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Busulfan; Care and treatment; Conditioning; Diagnosis; Feasibility Studies; Female; Fever; Fludarabine; Gastrointestinal Diseases - chemically induced; Health aspects; Hematologic Neoplasms - complications; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Histocompatibility antigen HLA; Hospitalization; Humans; Incidence; Length of Stay; Male; Medical sciences; Melphalan; Middle Aged; Neutropenia; Neutropenia - chemically induced; Patients; Risk analysis; Risk Factors; Siblings; Stem cell transplantation; Stem cells; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Transplantation, Homologous; Transplantation, Isogeneic; Spain; Human; Treatment; allogeneic stem cell transplantation; Stem cell; Hematopoietic cell; Homograft; conditioning-related toxicities; Graft; Feasibility; outpatient transplantation; Ambulatory; Non myeloablative treatment
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1704254

Allogeneic stem cell transplantation (allo-SCT) after a reduced-intensity conditioning (RIC) protocol is associated with decreased short-term toxicity. This suggests that the procedure could be performed on an outpatient basis. We analysed the incidence and risk factors of grade >or=2 conditioning-related toxicities (CRTs) as a hallmark for hospital admission, in 41 consecutive patients allografted from an HLA identical sibling after RIC. The RIC regimen consisted of fludarabine plus melphalan for lymphoid malignancies, and fludarabine plus busulphan for myeloid malignancies. In all, 11 patients (27%) did not experience any toxicity. The more frequent CRTs observed were neutropenic fever and gastrointestinal toxicity. The median duration of hospitalisation was 27 (range, 17-50) days. If allo-SCT had been planned as an outpatient procedure and admission indicated only in the case of >or=2 CRTs, the inpatient period would have decreased to 9 (range, 0-33) days (P<0.001). No risk factors for CRTs were identified. Allo-SCT after an RIC regimen is a well-tolerated procedure. Our results warrant a prospective pilot trial of nonmyeloablative allo-SCT performed in the outpatient setting.