Outpatient Management of Both Myeloablative and Reduced-Intensity Allogeneic HCT Results in Low Non-Relapse Mortality Irrespective of HCT-CI.

Myeloablative allogeneic hematopoietic transplantation continues to be performed as an inpatient procedure from the start of the preparative regimen until neutrophil recovery in most centers. Advances in supportive care and improved remission status pre-transplant may enable predominantly outpatient management of such patients during their transplant. We have analyzed transplant outcomes for consecutive unselected allogeneic transplants performed at our center between February 2005 and June 2006. Patients were scheduled to be admitted to the inpatient unit for less than one day for the stem cell infusion. The remainder of the transplant procedure including the preparative regimen and the period of pancytopenia prior to hematopoietic recovery were managed in the outpatient setting. Patients were admitted to the inpatient BMT unit for the management of complications only. Outpatient care was performed in a dedicated, fully HEPA-filtered facility with detailed infection control measures. If necessary, patients were admitted directly to the inpatient unit and use of the emergency department of the hospital was avoided. Patients were assessed daily for a minimum of 28d post HCT. Fifty-nine patients underwent first allogeneic HCT using non-cord blood donors during the period (median age 41 (21–63); 41 M, 18F; diagnoses - AML=17, ALL=11, NHL=8, MDS/MPS=7, MM=6, HD=2, OTH=7; Myeloablative=35, RIC =24; Related donors=38, MUD=21; ASBMT disease risk score - high=39, intermediate=4, low=16. Median inpatient stay from start of preparative regimen to d100 was 18d (1–63d). With a median follow-up of 565d (383–873d) for all patients, estimated probability of overall survival (OS) at 100d, 12m and 24m are 95%, 80% and 58% respectively. Corresponding probabilities of non-relapse mortality (NRM) are 3.5%, 14% and 23%. For patients undergoing myeloabative HCT, OS and NRM probabilities were 96%, 78%, 58% and 5%, 16%, 22% respectively. The HCT-comorbidity index (HCT-CI, Sorror et al Blood106:2912 [2005]) was used to assess co-existing morbidities. Probabilities of OS and NRM by HCT-CI risk group are shown in the Table. These data suggest that planned outpatient management of allogeneic HCT including myeloblative HCT can be performed without compromising OS and NRM if the appropriate facilities are provided.