Bone Marrow Outpatient Hematopoietic Transplantation Comes of Age STORY HIGHLIGHTS The most recent innovation in hematopoietic cell transplantation enables the procedure — both allogeneic and autologous — to be done in an outpatient facility. Since it was first performed more than 50 years ago, bone marrow transplantation remains a lifesaving treatment option for patients with various types of cancers and nonmalignant hematologic disorders. Today, the procedure is referred to as hematopoietic cell transplantation, and its most recent innovation includes completion of the procedure — both allogeneic, using a healthy donor’s cells, and autologous, using a patient’s own cells — in an outpatient facility for select patients. John P. Chute, MD, professor of medicine in the Division of Hematology/Oncology, talks about the advance. What is the traditional protocol for hematopoietic cell transplantation? We perform hematopoietic cell transplantation for the treatment of patients with leukemia, lymphoma and a variety of hematologic malignancies. These transplants have been done as inpatient services where the patient stays in the hospital for up to 60 days to safely undergo the transplant and to recover. But the field has evolved so that a subset of patients can safely receive the hematopoietic cell transplant as outpatients, which we now are doing at UCLA. The procedure entails collecting peripheral blood or bone marrow stem cells from the patient (autologous) or from a healthy donor (allogeneic), administering immunosuppressive chemotherapy to the patient, and then infusing the donor hematopoietic cells into the patient. In allogeneic hematopoietic cell transplant recipients, immune-suppressive medications are administered for three-to-six months. How does outpatient hematopoietic cell transplantation benefit patients? Patients have less risk of infection out in the world compared to when they are hospitalized. In addition, psychologically and emotionally, patients and caregivers appreciate not being in a hospital for one-to-three months. Hospitalization for that long can be a depressing experience. The third benefit is that the cost for outpatient treatment is significantly less — thousands of dollars less per day — than for inpatient care. UCLAHEALTH.ORG 1-844-4UCLADR (1-844-482-5237) What are some of the scientific advances that have made outpatient hematopoietic cell transplantation successful? Our knowledge has increased over the past decade in terms of identifying the lowest-risk patients and understanding how such patients can be treated safely as outpatients. One advance is in our ability to deliver blood products and antibiotics in the outpatient setting. Another is the development of powerful immunosuppressive medications that allow engraftment of donor hematopoietic cells in patients without the need for more toxic, high-dose chemotherapy or irradiation. Healthcare providers have also come to understand that nearly the identical supportive therapies administered in the hospital can be provided in the clinic. Many of these patients will need platelet or red-blood-cell transfusions or antibiotics every day. Previously, such patients required admission to the hospital, but we are now able to administer transfusions and antibiotics efficiently in the clinic or via home healthcare services. Describe allogeneic transplantation and how this type of transplant is done for an outpatient. Allogeneic transplantation — cells taken from a healthy donor — traditionally has been done in the hospital. But we will perform non-ablative allogeneic transplantation in the outpatient