High-dose chemotherapy with autologous stem cell rescue in the outpatient setting

Intensive outpatient care is rapidly becoming the primary mode of care for selected patients undergoing high-dose chemotherapy with autologous periphe ral blood stem cell (PBSC) transplantation, Although the traditional inpati ent model of care may still be necessary for high-risk patients, published data suggest that outpatient care is safe and feasible during or after admi nistration of high-dose chemotherapy and autologous PBSC transplant. Blood and marrow transplant (BMT) centers have developed programs to provide more outpatient care under three basic models: an early discharge model, a dela yed admission model, and a comprehensive, or total, outpatient model. This review will describe these models of care and address the elements necessar y for the development of an outpatient BMT program, including patient selec tion, staff development, and patient and caregiver education. Available sup portive care strategies to facilitate outpatient care will also he highligh ted. Clinical outcome data and pharmacoeconomic analyses evaluating various outpatient BMT programs, as well as limited quality-of-life evaluations, w ill be reviewed.