Can an autologous stem cell transplant be given in the outpatient setting?

Can ASCT be given in the outpatient setting?

What does it mean to be an outpatient?

What are the benefits and risks of inpatient vs outpatient?

The good news is the reason we can even contemplate an outpatient transplant is that these procedures are becoming so common and so safe that the patient doesn't have to be put in that bubble that we used to put people in and quarantine them throughout that neutropenic phase.

So we have much better supportive care, much better antibiotics and other drugs to really help with the side effects of the transplant and support patients through that recovery.

So a lot of times who gets an inpatient transplant. Who gets an outpatient transplant often has to do more with the setup of the particular facility you're in and the resources that they have.

So there are centers that will do all of their transplants as outpatients because they have put in the personnel and the staffing to their outpatient facility so that they can see you every day 24/7 and be able to provide the same kind of care that you do as an inpatient.

And then there are other centers that do not have those kind of set ups and they feel it's safer to keep their patients in the hospital.

But the majority of centers are actually probably doing some kind of hybrid model where you get admitted to the hospital for some of the initial treatments and then you're discharged before your recovery and followed as an outpatient for your recovery.

And only readmitted for any complications.

I don't think there's any particular differences in outcomes because your particular center is doing what they feel is the safest.

And so from you personally, you shouldn't have a fear whether it's done inpatient outpatient, it comes down more to social support and resources that you may have that might help you determine whether you want to do inpatient and outpatient.

If you don't have a good caregiver or your caregiver can only help for a certain amount of time, it may help for you to stay inpatient where you have the staff as your caregiver for part of that to help you.

If you have good caregivers, you live close to the center. It may be better for you to be home. You're not exposed to all those other patients who are in the hospital who may be there for infectious reasons.

And so I think there's pluses and minuses to both.

What does it mean to be an outpatient during an ASCT?

So I think every center feels the same way when we talk about outpatient. It’s not like you just go home and come back next week. You're actually having to come into the clinic potentially every single day doing that recovery.

And so to do so, you need to be a certain distance from the center. And so most of us have a radius of like perhaps 20 miles.

If you live in New York City, for example, 20 miles could be 5 hours.

So I think they have more of a time of how close you need to be to the center just to be safe, that you will be able to get there quickly and that it will not be a roadblock to you getting to the treatment.

But the reason we do that is because when you have no immune system, if you do have a fever, we assume it could be an infection, for example.

And time is of the essence.

And so you do need to get seen immediately.

And you don't want to be driving in for two or three hours.

Transplant can be done inpatient or outpatient.

Most of the time, where we do it depends on medical factors, social factors, insurance.

So sometimes age is an issue, but as long as patients have social support and they have a caregiver that can bring them back and forth to the clinic.

They're healthy.

They don't have lots of co-morbid medical conditions.

Almost every patient can have this procedure as an outpatient, at least start off that way.

If they start getting sick where they need continuous IV fluids or some more support for I.V. antibiotics, we can always admit them, but we try to do as many outpatient procedures as possible because the best place to heal is at home.

The best place to sleep is in your own bed, not a hospital bed.

And your infectious risk is also lowest at home as opposed to the hospital.

Some patients don't have that availability of caregiver support.

They don't have anyone that can drive them to the clinic every day while the patients are going through transplant, they can't drive.

So for those patients, they end up in the hospital

Our practice at Moffitt is to offer our patients routinely as long as they have no additional risk factors.

A patient trials that we have a most outpatient transplant program and that has is associated with high degree of patient satisfaction.

They love not being constrained to the unit constraints to the hospital.

And once they've been seen on a daily basis and assessed and treated for any of the complications that they might be having, such as nausea or diarrhea, replacing byproducts as they need them or hydration, then they can go back to where they're staying if they live near by the hospital, that's to their home.

And if they live further away than they arrange for local lodging, and then they can have that freedom to not be constantly in the hospital. And that practice has a high level of safety, a high level of patient satisfaction.

And as I said, two thirds of our patients never get admitted to the hospital.

Obviously, if any patient develops a fever while their have their immune immune system compromised, they get admitted immediately.

And that's why we ask them to be very close by.

There are certain patient populations that we do offer inpatient to transplant to, and those patients would be those patients, for example, who have significant renal impairment or who are on dialysis or have additional health concerns.

So, for example, some patients have additional health concerns that we're worried about how they'll tolerate, for example, the fluid shifts, it's diarrhea or other complications that might arise.

And so those patients we will offer admission to.

But generally speaking, most of our patients have their transplant is in a patient and they really prefer that process.