Introduction: Autologous stem cells have greatly influenced the treatment of a variety of malignancies including Hodgkin/non-Hodgkins lymphoma and acute leukemias. This is a preliminary study comparing the time of engraftment, mortality rate and cost of treatment in outpatient versus inpatient autologous stem cell transplantation (SCT) in Iran.
Patients and Methods: 11 outpatients (6 Hodgkin Lymphoma (HL), 3 Non-Hodgkin Lymphoma (NHL) and 2 Acute Myeloid Leukemia (AML)) were compared with 32 inpatients (15 HL, 8 NHL and 9 AML) from May, 2008 to December, 2008. All patients were in complete remission and without significant organ failure. They received conditioning regimen (CEAM for NHL and HL, Busulfan and Etoposide for AML) and stem cell infusion in hospital. The day after SCT, the outpatient group was discharged and followed up by an outpatient SCT team to be re-hospitalized, if indicated.
Results: For outpatients and inpatients, the median period to WBC engraftment was 11 and 12 days (p-value=0.03), the timeframe to PLT engraftment was 15 and 25 days (p-value=0.20) and the number of transfused single-donor PLT was 3 and 4.5 units (p-value=0.21). The duration of neutropenic fever was 6 and 9 days (p-value=0.001), the duration of hospitalization after SCT was 0 and 16 (p-value<0.001), respectively. All outpatients are alive but three inpatients died between days +35 and +100 following SCT due to transplantation complications. The cost of the drugs used for treatment of neutropenic fever was 6 times higher in the inpatient group.
Conclusion: The outpatient autologous SCT in malignant hematological disorders is feasible and comparable to inpatient protocols in Iran.