CLINICAL NEWS
Comparing Quality of Life Between Inpatient and Outpatient
Hematopoietic Cell Transplantation for Myeloma
Although previous research has shown that outpatient
autologous hematopoietic cell transplantation (AHCT) is
safe and feasible for patients with multiple myeloma (MM)
– and could avoid the weeks of isolation and emotional
distress associated with inpatient AHCT – results from a
prospective cohort study of 140 patients suggest that there
is no significant difference in quality of life (QOL) between
the inpatient and outpatient settings. The findings were
published in Biology of Blood and Marrow Transplantation.
“There is a general belief among transplant clinicians
that patients experience the highest degree of distress
while hospitalized for AHCT and [that outpatients] will
generally have a better perception of well-being,” noted
Massimo Martino, MD, from the Department of Hema-
to-Oncology and Radiotherapy at the Great Metropolitan
Hospital in Reggio Calabria, Italy,
and co-authors. The findings reported
in this study, however, demonstrate
that “the outpatient model of AHCT
neither improves nor impairs global
patient QOL, including physical and
psychological status.”
The study included transplant-
eligible patients with newly diagnosed
MM receiving care at the Great Met-
ropolitan Hospital between September
2012 and June 2016. Patients were
excluded if they had Waldenström
macroglobulinemia or immunoglobu-
lin M MM, or disease that was refrac-
tory to induction chemotherapy.
Patients were invited to choose
from two models of AHCT:
• early-discharge outpatient model
(EDOM; n=64; median age = 57.14
years; range not provided)
• total-inpatient model (TIM; n=76;
range = 56.9 years; range not
provided)
Patients in the EDOM group were
required to have access to a 24-hour
caregiver, housing within a one-hour
drive from the transplant center, and
the capability of adequately performing
(autonomously or under caregiver super-
vision) daily activities such as walking,
eating, and personal hygiene.
All patients received bortezomib-
based induction therapy in combination
with corticosteroids with or without
thalidomide in the outpatient setting.
Conditioning therapy consisted of high-
dose melphalan (220 mg/m 2 ).
The researchers measured QOL with
the self-administered Functional Assess-
ment of Cancer Therapy-Bone Marrow
Transplant Scale (FACT-BMT) at three
timepoints: seven days prior to high-
dose melphalan administration (baseline
T1), seven days post-AHCT (T2), and
30 days post-AHCT (T3). FACT-BMT
assesses QOL on several dimensions (in-
cluding physical, emotional, functional,
and social/family well-being); scores
range from 0 to 148, with a higher score
representing better QOL.
Differences in toxicity were “negligi-
ble” between the two AHCT approaches,
the authors reported, except for episodes
of fever and vomiting, which occurred
more frequently in the TIM group than
the EDOM group (p<0.05). Two patients
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