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Jantunen E, Partanen A, Turunen A, Varmavuo V, Silvennoinen R. Mobilization Strategies in Myeloma Patients Intended for Autologous Hematopoietic Cell Transplantation. Transfus Med Hemother 2023; 50:438-447. [PMID: 37899993 PMCID: PMC10603622 DOI: 10.1159/000531940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Multiple myeloma is currently the leading indication for autologous hematopoietic cell transplantation (AHCT). A prerequisite for AHCT is mobilization and collection of adequate blood graft to support high-dose therapy. Current mobilization strategies include granulocyte colony-stimulating factor (G-CSF) alone or in combination with chemotherapy most commonly cyclophosphamide (CY). More recently, plerixafor has become into agenda especially in patients who mobilize poorly. In the selection of a mobilization method, several factors should be considered. Summary Preplanned collection target is important as G-CSF plus plerixafor is more effective in the mobilization of CD34+ cells than G-CSF alone. On the other hand, CY plus G-CSF is superior to G-CSF only mobilization. Previous therapy and age of the patients are important considerations as G-CSF alone may not be effective enough in patients with risk factors for poor mobilization. These factors include extensive lenalidomide exposure, irradiation to bone marrow-bearing sites, higher age, or a previous mobilization failure. Also, local preferences and experiences as well as the number of apheresis needed are important issues as well as cost-effectiveness considerations. Mobilization method used may have implication for cellular composition of collected grafts, which might have an impact on posttransplant events such as hematologic and immune recovery in addition to also potential long-term outcomes. Key Message Currently, G-CSF alone and preemptive plerixafor if needed might be considered as a standard mobilization strategy in MM patients intended for AHCT.
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Affiliation(s)
- Esa Jantunen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Anu Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Antti Turunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - Raija Silvennoinen
- Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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2
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Hu CC, Subramanian R, Grigg A. Evaluation of a safe neutrophil count for cessation of intravenous antibiotics and early hospital discharge in stable, afebrile patients recovering after acute myeloid leukemia therapy or an autograft. Leuk Lymphoma 2023; 64:1322-1329. [PMID: 37081819 DOI: 10.1080/10428194.2023.2203289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
Currently there are no guidelines on a safe neutrophil count(ANC) for intravenous antibiotic(IVAB) cessation and hospital discharge in patients recovering after febrile neutropenia(FN). We assessed the safety in selected patients after recent FN of prompt IVAB cessation and hospital discharge. Safety was defined as no fever recurrence after IVAB cessation and readmission in the 10-days post-discharge for infections.A retrospective, single center audit conducted on 92 adult hematology patients admitted with de novo acute myeloid leukemia (AML) for intensive chemotherapy or for an autograft. Most admissions (n = 128/141;91%) were complicated by FN. Half of FN episodes ceased IVAB promptly with a median(range) ANC of 0.6(0.1-4.9x109/L); none of these episodes had recurrent fever requiring IVAB resumption. Prompt discharge occurred in 45% overall. Subsequent unplanned readmission rates were low.In afebrile, stable AML and autograft patients without medico-social barriers to discharge, IVAB can be ceased and hospital discharges safely done ≤24h of ANC ≥ 0.2x109/L.
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Affiliation(s)
- Chih-Chiang Hu
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| | - Rakhee Subramanian
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
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3
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Chimeric Antigen Receptor T-Cell Therapy: What We Expect Soon. Int J Mol Sci 2022; 23:ijms232113332. [PMID: 36362130 PMCID: PMC9657035 DOI: 10.3390/ijms232113332] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
The treatment landscape for hematologic malignancies has changed since the recent approval of highly effective chimeric antigen receptor T-cell therapies (CAR-T). Moreover, more than 600 active trials are currently ongoing. However, early enthusiasm should be tempered since several issues are still unsolved and represent the challenges for the coming years. The lack of initial responses and early relapse are some hurdles to be tackled. Moreover, new strategies are needed to increase the safety profile or shorten the manufacturing process during CAR-T cells therapy production. Nowadays, most clinically evaluated CAR-T cells products are derived from autologous immune cells. The use of allogeneic CAR-T cells products generated using cells from healthy donors has the potential to change the scenario and overcome many of these limitations. In addition, CAR-T cells carry a high price tag, and there is an urgent need to understand how to pay for these therapies as many of today’s current payment systems do not feature the functionality to address the reimbursement gap. Finally, the clinical experience with CAR-T cells for solid tumors has been less encouraging, and development in this setting is desirable.
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4
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Bhere D, Choi SH, van de Donk P, Hope D, Gortzak K, Kunnummal A, Khalsa J, Revai Lechtich E, Reinshagen C, Leon V, Nissar N, Bi WL, Feng C, Li H, Zhang YS, Liang SH, Vasdev N, Essayed WI, Quevedo PV, Golby A, Banouni N, Palagina A, Abdi R, Fury B, Smirnakis S, Lowe A, Reeve B, Hiller A, Chiocca EA, Prestwich G, Wakimoto H, Bauer G, Shah K. Target receptor identification and subsequent treatment of resected brain tumors with encapsulated and engineered allogeneic stem cells. Nat Commun 2022; 13:2810. [PMID: 35589724 PMCID: PMC9120173 DOI: 10.1038/s41467-022-30558-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
Cellular therapies offer a promising therapeutic strategy for the highly malignant brain tumor, glioblastoma (GBM). However, their clinical translation is limited by the lack of effective target identification and stringent testing in pre-clinical models that replicate standard treatment in GBM patients. In this study, we show the detection of cell surface death receptor (DR) target on CD146-enriched circulating tumor cells (CTC) captured from the blood of mice bearing GBM and patients diagnosed with GBM. Next, we developed allogeneic "off-the-shelf" clinical-grade bifunctional mesenchymal stem cells (MSCBif) expressing DR-targeted ligand and a safety kill switch. We show that biodegradable hydrogel encapsulated MSCBif (EnMSCBif) has a profound therapeutic efficacy in mice bearing patient-derived invasive, primary and recurrent GBM tumors following surgical resection. Activation of the kill switch enhances the efficacy of MSCBif and results in their elimination post-tumor treatment which can be tracked by positron emission tomography (PET) imaging. This study establishes a foundation towards a clinical trial of EnMSCBif in primary and recurrent GBM patients.
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Affiliation(s)
- Deepak Bhere
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC, 29201, USA
| | - Sung Hugh Choi
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Pim van de Donk
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - David Hope
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kiki Gortzak
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Amina Kunnummal
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jasneet Khalsa
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Esther Revai Lechtich
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Clemens Reinshagen
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Victoria Leon
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Nabil Nissar
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Cheng Feng
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Hongbin Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Yu Shrike Zhang
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven H Liang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Neil Vasdev
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Pablo Valdes Quevedo
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Alexandra Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Naima Banouni
- Department of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Anna Palagina
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Reza Abdi
- Department of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Brian Fury
- UC Davis Institute for Regenerative Cures, Davis, CA, 95817, USA
| | - Stelios Smirnakis
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Alarice Lowe
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
| | - Brock Reeve
- Harvard Stem Cell Institute, Harvard University, Cambridge, MA, 02138, USA
| | - Arthur Hiller
- Amasa Therapeutics Inc., 1 Harmony Lane, Andover, MA, 01810, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Glenn Prestwich
- Department of Medicinal Chemistry, College of Pharmacy University of Utah, Salt Lake City, UT, 84112, USA
- Washington State University Health Sciences, Spokane, WA, 99202, USA
| | - Hiroaki Wakimoto
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Gerhard Bauer
- UC Davis Institute for Regenerative Cures, Davis, CA, 95817, USA
| | - Khalid Shah
- Center for Stem Cell and Translational Immunotherapy (CSTI), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- Harvard Stem Cell Institute, Harvard University, Cambridge, MA, 02138, USA.
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Gómez-Almaguer D, Gómez-De León A, Colunga-Pedraza PR, Cantú-Rodríguez OG, Gutierrez-Aguirre CH, Ruíz-Arguelles G. Outpatient allogeneic hematopoietic stem-cell transplantation: a review. Ther Adv Hematol 2022; 13:20406207221080739. [PMID: 35237396 PMCID: PMC8882949 DOI: 10.1177/20406207221080739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is usually performed in
well-equipped units inside a hospital. The cost of this in-hospital transplant
is usually very high; therefore, this procedure is more difficult to perform in
low- and middle-income countries. Autologous outpatient HSCT is now a common
procedure; however, outpatient allogeneic transplants are more complicated. Only
a few centers in the world have incorporated outpatient HSCT. This transplant
requires special adaptation, like a day hospital, careful selection of patients,
oral medications, and the patient must live relatively close to the hospital.
The results until now suggest that this outpatient transplant is factible and
similar to inpatient HSCT. The objective was to review and describe the
different methods and results following an outpatient allogeneic-HSCT
strategy.
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Affiliation(s)
- David Gómez-Almaguer
- Hematology Service, Facultad de Medicina y Hospital Universitario ‘Dr. Jose Eleuterio Gonzalez’, Universidad Autónoma de Nuevo León, Francisco I. Madero Ave., Mitras Centro, Monterrey 64460, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Perla R. Colunga-Pedraza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Olga G. Cantú-Rodríguez
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - César Homero Gutierrez-Aguirre
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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6
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Choon-Quinones M, Zelei T, Barnett M, Keown P, Durie B, Kaló Z, Almási T, Harousseau JL, Hose D. Beyond medicines' barriers: exploring the true cost of multiple myeloma. J Med Econ 2022; 25:1167-1175. [PMID: 36397678 DOI: 10.1080/13696998.2022.2133823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM The goal of this research was to quantify and qualify all the costs associated with multiple myeloma (MM) from a healthcare and societal perspective and to highlight certain costs that are often underestimated. MATERIALS AND METHODS The study used a mixed methods approach that consisted of three phases: a systemic literature review (SLR), a virtual roundtable discussion based on the results of the SLR, and an online survey. RESULTS In total, 4321 records were identified by literature and snowball searches. After applying the eligibility criteria, 49 articles were included in the narrative summary. As combination treatments have become the mainstay of MM treatment, drug costs have become the most important component of the total healthcare costs. Collected evidence suggests that optimizing treatment pathways, besides prolonging patient survival and maintaining quality of life, has the potential to generate cost savings for all stakeholders (payers and patients). Improved patient access to new therapies that can improve outcomes may reduce the "financial toxicity" of MM by decreasing patients' and caregivers' productivity loss due to better prognosis and it also has the potential of reducing patients' direct health care payments. LIMITATIONS Heterogeneity of research objectives of included studies, costing methods, and applied measurement units limited the comparability of cost data between studies. Data for more than half of the world's population, including China, Russia, the Middle East, and Africa were not investigated. CONCLUSION While treatment costs are burdensome for healthcare systems, it is only one of several items that make up the True Cost of MM. Understanding these burdens is one way to argue for optimized treatment pathways and improve patient outcomes by tearing down access barriers.
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Affiliation(s)
| | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | - Mike Barnett
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Paul Keown
- Syreon Research Institute, Budapest, Hungary
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Brian Durie
- International Myeloma Foundation, Studio City, CA, USA
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | | | | | - Dirk Hose
- Department of Hematology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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7
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Hospital and outpatient models for Hematopoietic Stem Cell Transplantation: A systematic review of comparative studies for health outcomes, experience of care and costs. PLoS One 2021; 16:e0254135. [PMID: 34383780 PMCID: PMC8360565 DOI: 10.1371/journal.pone.0254135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Abstract
The number of Hematopoietic Stem Cell Transplantations has risen in the past 20 years. The practice of outpatient Hematopoietic Stem Cell Transplantation programs is increasing in an attempt to improve the quality of patient care and reduce the demand for hospital admission. A systematic review of 29 comparative studies between in-hospital and outpatient treatment of Hematopoietic Stem Cell Transplantation, with no restriction by outpatient regime was conducted. This study aims to analyse the current evidence on the effects of the outpatient model on patient-centred outcomes, comparing both in-hospital and outpatient models for autologous and allogeneic HSCT using the Triple Aim framework: health outcomes, costs and experience of care. We found evidence on improved health outcomes and quality of life, on enhanced safety and effectiveness and on reduced overall costs and hospital stays, with similar results on overall survival rates comparing both models for autologous and allogeneic patients. We also found that the outpatient Hematopoietic Stem Cell Transplantation is a safe practice as well as less costly, it requires fewer days of hospital stay both for autologous and allogeneic transplantations. Under a situation of an increasing number of transplants, rising healthcare costs and shortages of hospital capacity, incorporating outpatient models could improve the quality of care for people requiring Hematopoietic Stem Cell Transplantation programs.
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Tan XN, Yew CY, Ragg SJ, Harrup RA, Johnston AM. Outpatient autologous stem cell transplantation in Royal Hobart Hospital, Tasmania: a single-centre, retrospective review in the Australian setting. Intern Med J 2021; 52:1242-1250. [PMID: 33949777 DOI: 10.1111/imj.15334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/14/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several international centres have published their experiences with outpatient autologous stem cell transplantation (ASCT) as treatment of haematological malignancies. AIM In this single-centre retrospective review, we aim to examine the outcomes of outpatient autograft and review healthcare resource utilization in the pre-cytopenic period. METHODS Patients undergoing ASCT in Royal Hobart Hospital, Tasmania between 2008 and 2018 had their records reviewed and key outcomes data collected based upon whether they received inpatient/outpatient ASCT. An outpatient ASCT was defined as conditioning as an outpatient; patients could then be managed with an elective admission during the cytopenic period or admission only when clinically indicated. RESULTS Of 231 ASCTs performed, 135 (58%) were as outpatients ASCTs: 59 used carmustine-etoposide-cytarabine-melphalan-conditioning for lymphoma (BEAM-ASCT) and 76 used high dose melphalan for myeloma and amyloidosis (MEL-ASCT). Approximately one-third of patients undergoing outpatient ASCT were admitted electively during nadir period; the majority of patients required minimal interventions prior to this time. The most common causes for unplanned hospitalization (which occurred in 71 of the 89 planned outpatient transplants, 80%) were febrile neutropenia (39%) and mucositis (35%). Age was the only risk factor identified to increase risk of requiring unplanned hospitalization. Use of oral antibiotic prophylaxis reduced febrile neutropenia rates amongst melphalan-outpatient-ASCT. Outpatient-ASCTs led to significantly reduced inpatient bed-days and overall cost (approximately AUD $13000- $16,000) compared with inpatient autografts, with no significant differences in engraftment, rates of febrile neutropenia, intensive care admissions or mortality. CONCLUSION Outpatient autografts may save healthcare resources without compromising patient outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xuan Ni Tan
- Sir Charles Gairdner Hospital, Western Australia & University of Western Australia
| | - Chang Yang Yew
- Armadale Health Service, Western Australia & candidate in Master of Biostatistics, University of Sydney
| | - Scott J Ragg
- Royal Hobart Hospital, Tasmania & University of Tasmania
| | | | - Anna M Johnston
- Clinical Haematologist and Director of Haematology and Statewide Bone Marrow Transplant Service, Royal Hobart Hospital, Tasmania & University of Tasmania
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9
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Martino M, Pitino A, Tripepi G, Paviglianiti A, Russo L, Cusumano G, Rossetti A, Provenzano PF, Porto G, Meliambro N, Gallo S, Porcino D, Romeo V, Gangemi T, D'Arrigo G, Imbalzano L, Console G, Gori M. The Burden in Caregivers of Multiple Myeloma Patients Undergoing Outpatient Autologous Stem-Cell Transplantation Compared to Inpatient Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e402-e409. [PMID: 33288484 DOI: 10.1016/j.clml.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The application of different models of autologous stem-cell transplantation (ASCT) in multiple myeloma has demonstrated the feasibility and safety of outpatient-based programs of care. Although several systematic reviews have evaluated the burden of caregivers, only a few studies have included outpatient ASCT. PATIENTS AND METHODS The feelings of lack of family support, daily activities, and general health were compared between caregivers of 2 groups of patients with multiple myeloma who underwent inpatient (n = 71) or outpatient (n = 25) ASCT. RESULTS The 3 features did not significantly differ between the 2 study groups at baseline, before, and 3 months after ASCT. Multivariate modeling showed that the baseline values were significantly related to the changes in study outcomes independent of patient and caregiver characteristics. Other correlates were caregivers' work and patient age for impact on daily activities and disease burden across time for impact on general health (all P < .05). CONCLUSION The outpatient model neither improves nor impairs global caregivers' burden compared to standard ASCT care. Further research is needed to confirm this observation and to better assess the burden and quality of life of caregivers and their influence on patient outcomes and quality of life.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
| | | | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Letteria Russo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppa Cusumano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Antonio Rossetti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Pasquale Fabio Provenzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Gaetana Porto
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Nicola Meliambro
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Salvatore Gallo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Domenico Porcino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Valentina Romeo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Tiziana Gangemi
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Lucrezia Imbalzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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Martino M, Paviglianiti A, Memoli M, Martinelli G, Cerchione C. Multiple Myeloma Outpatient Transplant Program in the Era of Novel Agents: State-of-the-Art. Front Oncol 2020; 10:592487. [PMID: 33262948 PMCID: PMC7686536 DOI: 10.3389/fonc.2020.592487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023] Open
Abstract
Multiple myeloma (MM) is the most common indication for autologous stem cell transplantation (ASCT), and outpatient models have been widely developed in this setting. Although numerous studies have demonstrated the safety and feasibility of outpatient ASCT, it is not a routine procedure. Stringent guidelines for patient selection and clinical management, including functional status, caregiver support, and psychological aspects, are essential to identify eligible patients. However, there is still no general agreement on these criteria. Quality of life data are limited and contradictory. There is considerable variability in outpatient transplant models, and there are no randomised studies supporting the use of one over the other. Studies evaluating results in terms of long-term survival, transplant toxicity in comparison with a standard approach are lacking. The procedure is cost-effective within the context of a hospital budget, but an in-depth analysis of the real cost of these programmes has yet to be performed.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Mara Memoli
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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11
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Go JA, Weng CY. Process Mapping and Activity-Based Costing of the Intravitreal Injection Procedure. Curr Eye Res 2020; 46:694-703. [PMID: 32940071 DOI: 10.1080/02713683.2020.1825747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE/AIM OF THE STUDY To quantify the cost of performing an intravitreal injection (IVI) utilizing activity-based costing (ABC), which allocates a cost to each resource involved in a manufacturing process. MATERIALS AND METHODS A prospective, observational cohort study was performed at an urban, multi-specialty ophthalmology practice affiliated with an academic institution. Fourteen patients scheduled for an IVI-only visit with a retina ophthalmologist were observed from clinic entry to exit to create a process map of time and resource utilization. Indirect costs were allocated with ABC and direct costs were estimated based on process map observations, internal accounting records, employee interviews, and nationally-reported metrics. The primary outcome measure was the cost of an IVI procedure in United States dollars. Secondary outcomes included operating income (cost subtracted from revenue) of an IVI and patient-centric time utilization for an IVI. RESULTS The total cost of performing an IVI was $128.28; average direct material, direct labor, and overhead costs were $2.14, $97.88, and $28.26, respectively. Compared to the $104.40 reimbursement set by the Centers for Medicare and Medicaid Services for Current Procedural Terminology code 67028, this results in a negative operating income of -$23.88 (-22.87%). The median clinic resource-utilizing time to complete an IVI was 32:58 minutes (range [19:24-1:28:37]); the greatest bottleneck was physician-driven electronic health record documentation. CONCLUSIONS Our study provides an objective and accurate cost estimate of the IVI procedure and illustrates how ABC may be applied in a clinical context. Our findings suggest that IVIs may currently be undervalued by payors.
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Affiliation(s)
- Jonathan A Go
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Christina Y Weng
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.,Department of Ophthalmology, Ben Taub General Hospital, Harris Health System, Houston, Texas, USA
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Martino M, Rossi M, Ferreri A, Loteta B, Morabito A, Moscato T, Console G, Innao V, Naso V, Provenzano PF, Recchia AG, Gentile M. Quality of life outcomes in multiple myeloma patients: a summary of recent clinical trials. Expert Rev Hematol 2019; 12:665-684. [PMID: 31251688 DOI: 10.1080/17474086.2019.1634541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Management of multiple myeloma (MM) has improved over recent years. Health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes. Areas covered: The authors performed an expert review of the literature to identify evidence-based data available on HRQoL in frontline and relapsed/refractory MM (RRMM) patients. Expert opinion: De-novo patients should be informed that the HRQoL is expected to improve during first-line treatment with different degrees of possible deterioration during the first cycles. Achievement of a maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, HRQoL, and patient preferences. The same degree of improvement in HRQoL cannot be expected during conventional relapse treatments, where patients should be prepared only for stabilization of HRQoL. However, focusing attention only on measures such as toxicity may provide just a partial view of overall treatment effectiveness. Nonetheless, the authors believe the added value of taking into consideration the patient's perspectives and the importance of patient-reported outcomes in the evaluation of treatment effects should be considered mandatory. The incorporation of quality of life assessment into clinical and research practice has the potential of improving treatment outcomes.
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Affiliation(s)
- Massimo Martino
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Marco Rossi
- b Department of Experimental and Clinical Medicine, Magna Græcia University , Catanzaro , Italy
| | - Anna Ferreri
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Barbara Loteta
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Antonella Morabito
- c Pharmacy Unit, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Tiziana Moscato
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Giuseppe Console
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Vanessa Innao
- d Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina , Messina , Italy
| | - Virginia Naso
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Pasquale Fabio Provenzano
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- e Department of Hematology, Unità di Ricerca Biotecnologica (URB) , Cosenza , Italy
| | - Massimo Gentile
- f Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata , Cosenza , Italy
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Koo J, Silverman S, Nuechterlein B, Keating AK, Verneris MR, Foreman NK, Mulcahy Levy JM. Safety and feasibility of outpatient autologous stem cell transplantation in pediatric patients with primary central nervous system tumors. Bone Marrow Transplant 2019; 54:1605-1613. [PMID: 30783209 PMCID: PMC6957458 DOI: 10.1038/s41409-019-0479-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/09/2022]
Abstract
High-dose chemotherapy with autologous hematopoietic stem cell transplantation (autoHSCT) is a well-established treatment for pediatric central nervous system (CNS) tumors. Given the risks of toxicity and infection, pediatric autoHSCT has been historically performed on hospitalized children. As our practice evolved, some patients were transplanted as outpatients. We performed a retrospective cohort analysis of 37 patients who received 90 transplant procedures (49 outpatient and 41 inpatient) at Children’s Hospital Colorado. The most common primary diagnosis was medulloblastoma (51.4%). Of the patients transplanted as outpatients, 69.4% were admitted for fever and neutropenia and had a median time to hospitalization of day +6, with fever and neutropenia being the most common reasons for admission. The median time to neutrophil engraftment was the same in both cohorts, 11 days. Median time to platelet engraftment was 13 days (8–82 days) vs 16 days (8–106 days) (p = 0.0008). At day +100, the transplant-related mortality (TRM) was 0% for both the cohorts. At a median follow-up of 1.7 years, overall survival (OS) for all patients was 66.1% and TRM was 0% for both the cohorts. Outpatient autoHSCT for properly selected children with CNS tumors is safe and effective.
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Affiliation(s)
- Jane Koo
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA.
| | - Stacy Silverman
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Brandon Nuechterlein
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Amy K Keating
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael R Verneris
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Nicholas K Foreman
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA.,The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
| | - Jean M Mulcahy Levy
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA.,The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
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Owattanapanich W, Suphadirekkul K, Kunacheewa C, Ungprasert P, Prayongratana K. Risk of febrile neutropenia among patients with multiple myeloma or lymphoma who undergo inpatient versus outpatient autologous stem cell transplantation: a systematic review and meta-analysis. BMC Cancer 2018; 18:1126. [PMID: 30445930 PMCID: PMC6240267 DOI: 10.1186/s12885-018-5054-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023] Open
Abstract
Background Outpatient autologous stem cell transplantations (ASCTs) in multiple myeloma and lymphoma patients have been shown to reduce the overall costs and improve the quality of life relative to inpatient ASCTs. This systematic review and meta-analysis was performed with the aim of comprehensively comparing the risk of febrile neutropenia developing in ASCT outpatients and inpatients who have multiple myeloma or lymphoma. Methods To be eligible for the meta-analysis, studies needed to be either randomized, controlled studies or cohort studies. They also need to have two groups of patients with multiple myeloma or lymphoma who underwent ASCT, with the treatment being provided to one group in an outpatient setting and to the other on an inpatient basis. The studies had to report our primary outcome of interest, the rate of febrile neutropenia after stem cell infusion, for both groups. The Mantel–Haenszel method was used to pool the effect estimates and 95% confidence intervals of each study. Results From 9 eligible studies, a total of 1940 patients were included in the meta-analysis. Contrary to conventional concerns, the patients who underwent the outpatient ASCT had a significantly lower risk of developing febrile neutropenia than those admitted for ASCT, with a pooled odds ratio (OR) of 0.44 (95% confidence interval [CI]: 0.29–0.65; p < 0.0001; I2 = 52%). The risk of septicemia was also significantly lower for the outpatients than the inpatients, with a pooled OR of 0.40 (95% CI: 0.16–0.97; p = 0.04; I2 = 23%). Additional analyses found that the odds of having grade 2–3 mucositis and transplant-related mortality were numerically lower for the outpatient group, although the pooled result was not statistically significant. The odds of surviving at 2–3 years was also numerically higher for the ASCT outpatients, but the difference did not reach statistical significance. Conclusions This study found a significantly lower odds of developing febrile neutropenia and septicemia among patients with multiple myeloma and lymphoma who received an outpatient ASCT than among those who had an inpatient ASCT. Electronic supplementary material The online version of this article (10.1186/s12885-018-5054-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | | | - Chutima Kunacheewa
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Kannadit Prayongratana
- Division of Hematology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, 10400, Thailand
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