Reduced-intensity stem cell transplants, which don’t require the traditional week-long hospital stay, are offered to qualified patients at many cancer treatment centers across the country, including Dana-Farber/Brigham and Women’s Cancer Center. These outpatient transplants (also known as ambulatory transplants) are identical in virtually every respect to those performed on an inpatient basis, with the exception that patients and their caregivers spend nights and off-hours at home or other lodgings near the hospital.
Traditionally, patients receiving a reduced-intensity transplant — sometimes referred to as a “mini” transplant — are admitted to the hospital the day before treatment begins. They receive an infusion of chemotherapy, at a lower dose than in a standard transplant, every day for the next four days. After a day with no treatment, they’re infused with blood-forming stem cells from a compatible donor. If no complications arise, they’re usually discharged the following day. The total period of hospitalization is a minimum of eight days.
In an outpatient transplant, patients go home following each day’s treatment — or to a nearby hotel or other accommodations if they live far from the treatment center. This can help them feel more rested when they come in for treatment and enables them to eat foods they’re accustomed to, according to Corey Cutler, MD, MPH, medical director of the Stem Cell Transplantation Program at Dana-Farber. It also allows them to be more active than they would be at a hospital.
Not all patients undergoing a reduced-intensity transplant are candidates for the outpatient procedure, Cutler notes. They need to reside or lodge close enough to the hospital that they can travel back and forth daily for treatment. (Many treatment centers have programs to help patients find and access short-stay housing nearby.) Patients also need to be healthy enough that it’s safe for them to spend nights away from the hospital, and need to have a caregiver who can be with them at all times during the transplant period.
The low level of risk associated with reduced-intensity transplants makes them well-suited as outpatient procedures for many patients, Cutler remarks. If an unexpected health issue arises at any point, patients can be admitted to the hospital for further treatment or monitoring. Services offered in conjunction with transplants — nutritional counseling, educating caregivers on patients’ needs during and after treatment, pharmacy services, social work and financial counseling — are available for both inpatient and outpatient transplant recipients.