Research shows that outpatient stem cell transplants have higher survival rates than many inpatient alternatives for multiple myeloma patients.

In one study, only three of 272 patients had died by the 100th day after the transplants. Overall, only a one-percent mortality rate, a fifth of that of inpatient programs, is reported for outpatient programs.

One distinctive representative of outpatient treatment is the Mayo program. Relying on a team managed by two physicians with a staff of nurses and physician assistants, the Mayo Clinic in Rochester, Minn., accepts patients 76 years old or younger who are candidates for autologous stem cell transplant.

The clinic begins with chemotherapy two days before the stem cell transplant. After the transplant, patients are given a dosage of red blood cells and antibiotics, usually prescribed orally. Dr. Morie Gertz, chair of internal medicine at the Mayo Clinic, has not detected any difference in infection rates between outpatient and inpatient treatments.

“While this program appears to be safe, the paper also implies that they are achieving superior outcomes to inpatient therapy, and that is absolutely not true,” cautions Dr. Jayesh Mehta, researcher of oncology and hematology. He said that a selection bias affected the results.

Of 716 participants, only 39 percent of patients were able to complete the Mayo program. Twenty-nine percent of patients 65 years and older remained outpatients. Outpatients who were admitted had shorter stays than did inpatients in other programs.

“Outpatient stem cell transplant requires significant commitments on the part of the patients and their families,” said Dr. Mehta. Outpatients must have housing a short distance from the hospital.

Dr. Gertz pointed out that savings in an outpatient program can be substantial. Many transplant centers charge $2,000 a day for room, nursing care, and meals.

Source: OncologyStat