HIGH-DOSE CHEMOTHERAPY FOLLOWED BY AUTOLOGOUS BLOOD-CELL TRANSPLANTATION - A SAFE AND EFFECTIVE OUTPATIENT APPROACH

High-dose chemotherapy (HDCT) followed by autologous blood cell (ABC) transplantation has been used widely for patients with metastatic brea st cancer (MBC). It has been shown by our group and others to be an ef fective means of achieving very high response rates including complete remission, Therefore, further reduction in toxicity and increased pat ient satisfaction is necessary, Fifty-three patients with MBC were enr olled in a feasibility study at our cancer centre,vith a three-step ap proach to outpatient observation after HDCT and ABC transplantation di scharging our patients from hospital 6 days after reinfusion of ABC, 1 day after reinfusion of ABC and 1 day prior to reinfusion of ABC, The supportive care consisted of the use of 5-HT3 antagonists for nausea and vomiting, DMSO depletion, thorough body hygiene, prophylactic anti biotic, antifungal and virustatic drugs, In the event of febrile neutr openia, a standard evaluation and treatment was used, Only 22 patients were admitted for febrile neutropenia and two for haemorrhage, The me dian hospital stay was 2 days (range 1-7), The time to engraftment, ne ed for transfusion and other toxicities mere not different in patients who stayed entirely as outpatients, No toxic deaths occurred, In conc lusion, HDCT followed by ABC transplantation can be safely administere d to patients in the clinic with outpatient post-transplant observatio n.