Early morbimortality in autologous hematopoietic cell transplantation performed on outpatient basis in patients with autoimmune diseases: experience in 1700 patients

Abstract

Autologous hematopoietic cell transplantation (aHSCT) is a viable therapeutic approach in patients with autoimmune diseases. Since June 2015, we have autografted on an outpatient basis 1700 aHSCT patients. The objective was to analyze the salient features of early post-aHSCT complications when performed in the outpatient setting. The primary endpoints were early morbi-mortality-free survival (MFS) and overall survival (OS), whereas secondary endpoints entailed hospital admissions, neutropenic fever, Multiple Sclerosis (MS) flare-up, pneumothorax, hyponatremia and myocarditis. Following the “Mexican Method”; 1700 consecutive aHSCT recipients were analyzed: 1667 with MS, 29 with CIDP and 4 with other autoimmune diseases. A total of 1643 (96.6%) grafts were fully completed in the outpatient setting. The 30-day MFS and 30-day OS were 87.7% and 99.8%, respectively. The 30-day MFS has increased from 94.9% in the first 5 years to 98.2% in the last 5 years (p = 0.0002). The 28-day mortality was 0.17%, whereas the 28-day morbidity was 3.3%. The rate of early complications decreased over time, most likely reflecting a learning curve effect. These data support that employing our method is safe in the short term; as this has been done in a ‘trial’ setting, further research is needed.