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- Title
Outpatient high-dose melphalan in multiple myeloma patients.
- Authors
Kassar, Mohamad; Medoff, Erin; Seropian, Stuart; Cooper, Dennis L.
- Abstract
BACKGROUND: The brief period of neutropenia and limited nonmarrow toxicity after high-dose melphalan (HDM) provide a rationale for outpatient treatment. STUDY DESIGN AND METHODS: Our experience with HDM (140-200 mg/m2) in 90 consecutive transplant episodes was retrospectively reviewed. Most patients were treated in an outpatient setting. Patients without a primary care provider (PCP) were electively admitted before the anticipated onset of neutropenia. Ceftriaxone was added to ciprofloxacin at the onset of neutropenia. All febrile patients were admitted. RESULTS: The median time from peripheral blood progenitor cell infusion to onset of neutropenia was 5 days (range, 4-6 days), and the mean duration of neutropenia was 5 days (range, 4-7 days). Thirty-eight transplants (42%) were performed entirely in the outpatient setting. The mean duration of hospitalization was 2.2 days in patients not electively admitted. The use of ceftriaxone was associated with a decreased risk for fever (39% vs. 79%) and reduced duration of hospitalization (1.6 days vs. 4.5 days) for nonelectively admitted patients. There was no treatment-related mortality. CONCLUSION: Ambulatory therapy with HDM is safe and can be achieved in a general outpatient setting. The predictable time to neutropenia allows even poor candidates for outpatient therapy to be admitted electively on Day +4. The apparent beneficial effect of ceftriaxone needs to be confirmed in randomized trials.
- Subjects
NEUTROPENIA; MULTIPLE myeloma; B cell lymphoma; CIPROFLOXACIN; OUTPATIENT medical care; PRIMARY care; PLASMA cell diseases
- Publication
Transfusion, 2007, Vol 47, Issue 1, p115
- ISSN
0041-1132
- Publication type
Article
- DOI
10.1111/j.1537-2995.2007.01073.x