Safety and Cost-Effectiveness of Outpatient Autologous Stem Cell Transplantation in Patients with Multiple Myeloma
Safety and Cost-Effectiveness of Outpatient Autologous Stem Cell Transplantation in Patients with Multiple Myeloma
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DOI：
10.1016/j.bbmt.2012.12.006
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发表时间：
2013-04-01
影响因子：
4.3
通讯作者：
Kiss, Thomas L.
中科院分区：
文献类型：
--
作者：
Holbro, Andreas;Ahmad, Imran;Kiss, Thomas L.
高剂量化疗联合自体干细胞移植（ASCT）仍然是多发性骨髓瘤患者的标准治疗。考虑到等待时间和住院手术相关的费用，门诊ASCT可能是一个有吸引力的选择。我们在2006年启动了门诊移植方案。患者在大学医院门诊部接受治疗，该门诊部每周开放5天。本研究调查了门诊计划的安全性和成本效益。2006年至2010年间，91例患者接受了ASCT。大多数患者（77%）患有Dune-Salmon III期疾病; 38%患有1种或多种合并症。76例患者（84%）在前100天内住院，主要是发热性中性粒细胞减少症（n = 71）。第100天的总生存率为100%。无患者入住重症监护室。延长住院时间（超过7天）的风险因素是疾病分期JIB或更高，年龄>60岁。与住院ASCT相比，每位患者节省的费用为19，522加元，每年节省约740，000加元。总之，在工作日门诊对多发性骨髓瘤患者进行ASCT似乎是安全和具有成本效益的，但与相对较高的住院率相关。(C)2013年美国血液和骨髓移植协会。
High-dose chemotherapy with autologous stem cell transplantation (ASCT) remains the standard of care for patients with multiple myeloma. Outpatient ASCT can be an attractive option given wait times and costs associated with inpatient procedures. We initiated an outpatient transplantation protocol in 2006. Patients were treated at a university hospital outpatient clinic that was open 5 days a week. The present study investigated safety and cost-effectiveness of the outpatient program. Ninety-one patients underwent ASCT between 2006 and 2010. The majority of patients (77%) had Dune-Salmon stage III disease; 38% had 1 or more comorbidities. Seventy-six patients (84%) were hospitalized during the first 100 days, mainly for febrile neutropenia (n = 71). Overall survival at day 100 was 100%. No patient was admitted to an intensive care unit. Risk factors for prolonged hospitalization (longer than 7 days) were disease stage JIB or higher and age >60 years. The cost savings was $19,522 (Canadian dollars) per patient compared with inpatient ASCT, for an annual savings of approximately $740,000. In summary, outpatient ASCT performed in a weekday clinic for patients with multiple myeloma appears to be safe and cost-effective, but is associated with a relatively high hospitalization rate. (C) 2013 American Society for Blood and Marrow Transplantation.