{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:35:03Z","timestamp":1787841303824,"version":"build-2784847793"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"\n Background and objective:<\/jats:title>\n Autologous hematopoietic stem cell transplant (aHCT) has become standard care for patients with multiple myeloma (MM). Outpatient aHCT with high-dose melphalan conditioning has reduced costs and length of hospital stay. This study aimed to highlight the effectiveness, safety, and cost implications of outpatient vs inpatient aHCT at a tertiary academic medical center, as well as the utility of growth factor use in these patients.<\/jats:p>\n <\/jats:sec>\n \n Patients and methods:<\/jats:title>\n \n Using an institutional HCT database, a total of 100 patients undergoing aHCT for MM were identified; 50 patients who underwent aHCT in the outpatient setting (chemotherapy and stem cell infusion followed by inpatient admission if needed) were compared with 50 patients in the inpatient setting (chemotherapy and stem cell infusion followed by discharge to outpatient setting). Patients were excluded if the melphalan dose was less than 200 mg\/m\n 2<\/jats:sup>\n . Outcomes assessed through retrospective chart review included time to engraftment, incidence of infection, febrile neutropenia, growth factor use, and total length of inpatient stay through day +100.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Time to neutrophil and platelet engraftment was shorter in the outpatient group than in the inpatient group (14 vs 16 days and 19 vs 21 days, respectively;\n P <<\/jats:italic>\n 0.001). Median length of hospital stay was also shorter in the outpatient group (8.5 vs 15.5 days, respectively;\n P<\/jats:italic>\n < 0.001).\n <\/jats:p>\n \n Ninety percent of the outpatient group required admission for neutropenic fever, and 60% of these patients received growth factor support starting at a median of 9 days after stem cell infusion, for a median duration of 4 days. Compared to 16 patients who did not receive growth factor support, these patients had a significantly shorter time to neutrophil recovery (13 days with vs 15 days without growth factor,\n P<\/jats:italic>\n = 0.02) and no difference in the total length of hospital stay (8 days with vs 10 days without growth factor,\n P<\/jats:italic>\n = 0.43).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n For adult patients with MM undergoing aHCT, the outpatient setting is safe and reduces the total length of hospital stay and thus overall transplant costs. Growth factor support for patients with febrile neutropenia may not reduce length of stay for subsequent hospitalizations.<\/jats:p>\n <\/jats:sec>","DOI":"10.56875\/2589-0646.1038","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T11:29:51Z","timestamp":1686655791000},"page":"351-357","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Effectiveness, Safety, and Cost Implications of Outpatient Autologous Hematopoietic Stem Cell Transplant for Multiple Myeloma"],"prefix":"10.4103","volume":"16","author":[{"given":"Jessica","family":"Marini","sequence":"first","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Weeda","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarendra","family":"Neppalli","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Edwards","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,5,23]]},"reference":[{"issue":"11","key":"R1-20241211","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1056\/NEJMra1011442","article-title":"Multiple myeloma","volume":"364","author":"Palumbo","year":"2011","journal-title":"N Engl J Med"},{"issue":"10","key":"R3-20241211","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1111\/aor.13468","article-title":"Retrospective analysis of the efficacy and influencing factors of autologous hematopoietic stem cell transplantation for multiple myeloma","volume":"43","author":"Zhang","year":"2019","journal-title":"Artif Organs"},{"issue":"1","key":"R4-20241211","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1038\/leu.2012.160","article-title":"Improvement in long-term outcomes with successive Total Therapy trials for multiple myeloma: are patients now being cured?","volume":"27","author":"Usmani","year":"2013","journal-title":"Leukemia"},{"issue":"8","key":"R5-20241211","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1002\/ajh.25117","article-title":"Multiple myeloma: 2018 update on diagnosis, risk-stratification, and management","volume":"93","author":"Rajkumar","year":"2018","journal-title":"Am J Hematol"},{"key":"R6-20241211","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.bbmt.2012.12.006","article-title":"Safety and cost-effectiveness of outpatient Autologous stem cell transplantation in patients with multiple myeloma","volume":"19","author":"Holbro","year":"2013","journal-title":"Biol Blood Marrow Transplant"},{"issue":"1","key":"R7-20241211","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1537-2995.2007.01073.x","article-title":"Outpatient high-dose melphalan in multiple myeloma patients","volume":"47","author":"Kassar","year":"2007","journal-title":"Transfusion"},{"issue":"10","key":"R8-20241211","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.4065\/83.10.1131","article-title":"Autologous stem cell transplant in716 patients with multiple myeloma: low treatment-related mortality, feasibility of outpatient transplant, and effect of a multidisciplinary quality initiative","volume":"83","author":"Gertz","year":"2008","journal-title":"Mayo Clin Proc"},{"issue":"6","key":"R9-20241211","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/ejh.12970","article-title":"Inpatient vs. outpatient autologous hematopoietic transplantation for multiple myeloma","volume":"99","author":"Shah","year":"2017","journal-title":"Eur J Haematol"},{"issue":"7","key":"R10-20241211","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1038\/sj.bmt.1703389","article-title":"Second hematopoietic stem cell transplantation for the treatment of graft failure, graft rejection or relapse after allogeneic transplantation","volume":"29","author":"Wolff","year":"2020","journal-title":"Bone Marrow Transplant"},{"issue":"28","key":"R13-20241211","doi-asserted-by":"crossref","first-page":"3199","DOI":"10.1200\/JCO.2015.62.3488","article-title":"Recommendations for the use of WBC growth factors: American society of clinical practice guideline update","volume":"33","author":"Smith","year":"2015","journal-title":"J Clin Oncol"},{"issue":"1","key":"R14-20241211","first-page":"12","article-title":"Neutropenia recovery linked to filgrastim initiation timing after autologous hematopoietic stem-cell transplantation","volume":"6","author":"Janusek","year":"2016","journal-title":"J Hematol Oncol Pharm"},{"issue":"2","key":"R15-20241211","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.bbmt.2017.10.026","article-title":"Granulocyte colony-stimulating factor use after autologous peripheral blood stem cell transplantation: comparison of two practices","volume":"24","author":"Singh","year":"2018","journal-title":"Biol Blood Marrow Transplant"},{"issue":"22","key":"R16-20241211","doi-asserted-by":"crossref","first-page":"5790","DOI":"10.1182\/blood.V128.22.5790.5790","article-title":"G-CSF starting day +1 after autologous transplant is safer than day +5 or day +7 in patients with multiple myeloma","volume":"128","author":"Cottini","year":"2016","journal-title":"Blood"}],"container-title":["Hematology\/Oncology and Stem Cell Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.56875\/2589-0646.1038","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:49:10Z","timestamp":1787838550000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.56875\/2589-0646.1038"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,23]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.56875\/2589-0646.1038","relation":{},"ISSN":["1658-3876","2589-0646"],"issn-type":[{"value":"1658-3876","type":"print"},{"value":"2589-0646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,23]]}}}