Hematopoietic stem cell allografts using a non-myeloablative conditioning regimen can be safely performed on an outpatient basis: report of four cases

Using a non-myeloablative, immunosuppressive, fludarabine-based conditionin g regimen, we performed allogeneic peripheral blood stem cell transplants t otally on an outpatient basis in four patients (two with chronic myelogenou s leukemia, one with acute myelogenous leukemia and one with thalassemia ma jor). The median granulocyte recovery time to 0.5 x 10(9)/l was 10 days and the lowest absolute neutrophil count was 0.064 x 10(9)/l; only one patient developed thrombocytopenia below 20 x 10(9)/l. No patient required red blo od cell transfusions and one was given a single prophylactic platelet trans fusion. All patients are alive at 210-390 (median 285) days and have defini te evidence of chimerism; one-developed biopsy-proven GVHD on day 50, with a limited cutaneous rash. The procedure is less costly than its counterpart using myeloablative conditioning regimens and may represent another approa ch in the management of patients requiring an allogeneic stem cell transpla nt.