OUTPATIENT HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM-CELL RESCUE FOR HEMATOLOGIC AND NONHEMATOLOGIC MALIGNANCIES

Purpose: A prospective study to determine the feasibility of high-dose chemotherapy (HDC) and autologous stem-cell rescue (ASCR) in the outp atient setting. Methods: One hundred thirteen consecutive patients und erwent 165 cycles of HDC/ASCR for a variety of malignancies. HDC regim ens were disease-specific. Initially, patients were hospitalized for H DC, discharged on completion, and maintained as outpatients unless tox icities required rehospitalization (subtotal outpatient transplantatio n [STOT]), Once this was established as safe, a total outpatient trans plant (TOT) program was developed in which patients received all of th e HDC, as well as supportive care, as outpatients, Patients who declin ed the outpatient programs received the same HDC and supportive care a s inpatients. Results: In 140 of 165 (85%) HDC cycles, patients agreed to participate inane of the outpatient transplant programs. Five pati ents in the STOT program could not be discharged from the hospital bec ause of toxicities that developed during HDC; thus, 135 patients were monitored the outpatient setting, 95 (70%) of whom were never readmitt ed. The mean +/- SEM total hospital length of stay (LOS), including al l readmissions and excess days after chemotherapy, was 18.33 +/- 5.06 days for patients who refused the outpatient program, 8.22 +/- 5.76 da ys for patients in the STOT program, and 2.81 +/- 7.66 days for those in the TOT program (P <.001). One treatment-related death occurred in each treatment setting: day 120 inpatient, day 17 STOT, and day 110 TO T. Conclusion: Outpatient management of HDC/ASCR is safe and acceptabl e for the vast majority of patients. The STOT program resulted in sign ificant reduction in hospital LOS, while the TOT program appears equal ly safe and further reduces LOS. Hospitalization for HDC/ASCR is unnec essary in most patients. (C) 1997 by American Society of Clinical Onco logy.