Outpatient Autologous Stem Cell Transplants for Multiple Myeloma- Analysis of Safety and Outcomes in a Tertiary Care Center

Abstract Background Autologous stem cell transplant (ASCT) is the preferred consolidation strategy to treat eligible patients with Multiple Myeloma (MM) and related plasma cell dyscrasias. Given the increasing volume of patients and longer wait time, out-patient ASCT for MM is the standard of care at the Vancouver General Hospital. Patients and Methods Patients with MM, POEMS syndrome and Amyloidosis undergoing ASCT were included in this analysis. We analyzed patient characteristics, the number of patients requiring admission, duration of admission, 30 - day and 100-day mortality, and overall survival. Results Between January 2007 and June 2016, 724 patients underwent 752 ASCTs. Of these, 702 were first ASCTs, 44 were second and 6 were third. Median age was 60 years (IQR 54-65). Reasons for ASCTs were MM (96.9%) Amyloidosis (2.4%) and POEMS syndrome (0.7%). Males were 431(59.5%) of this group. The median time from diagnosis to transplant was 5 months. Conditioning was melphalan 200mg/m2 for 89.6% of the patients. Admission to the inpatient ward was required by 245 (32.6%) patients within the first 30 days. Median time to admission was 9 days post-transplant (IQR: day 5 to 13). Median duration of admission was 6 days (IQR: 3 to 9 days). Day 100 all-cause mortality rate was 0.9% and transplant related mortality (TRM) was 0.4%. Conclusion Outpatient ASCT is a safe and feasible treatment strategy with low TRM. Overall resource utilization are significantly lower than inpatient auto-transplantation: however, this requires a multidisciplinary approach with close follow up