Effects Of A Temporal Break Between Mobilization And Conditioning On Complications And Hospitalization Charges In Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplant (Asct).

e20002 Background: ASCT remains an important therapeutic modality in myeloma but can be associated with high cost, prolonged hospitalization and potential complications. We retrospectively analyzed whether a temporal break between stem cell mobilization (SCM) and conditioning (Cn) during ASCT would affect cost efficiency and reduce complications. Methods: Patients (Pts) who underwent melphalan-based ASCT at our hospital between Jan 2013 - Jun 2017 were included in the study. Based on the time interval between SCM and Cn, Pts were divided into two cohorts: No-break (≤ 2 days) Vs Break ((≥3 days). Data including incidence of neutropenic fever, bacteremia, intensive care unit (ICU) care, blood product use and hospitalization charges were collected. Pts with incomplete data or known prior infections were excluded. All Pts received granulocyte colony stimulating factor (GCSF) on day + 7. A Wilcoxon non-parametric test was used to compare the cohorts. Univariate and multivariate analyses were performed. Results: Study population included 127 patients. When compared to the break cohort (N = 62), patients without a break (N = 65) were 5.3 times more likely to have bacteremia (p = 0.0076) and 2.5 times more likely to have neutropenic fevers (p = 0.0315). There was no difference in length of stay but ICU care was lesser in break cohort (p = 0.0334) along with fewer platelet transfusions (p = 0.005). In multivariate analysis, bacteremia remained statistically significant despite method of SCM (GCSF + chemotherapy, GCSF alone, GCSF + Plerixafor) or levofloxacin prophylaxis. Median hospitalization charge was statistically different at $98,674 for Break-cohort Vs $107,111 for No-break cohort (p = 0.0469). Conclusions: Our results support the hypothesis that providing a temporal break between SCM & Cn may be associated with lower rates of infectious complications and better resource utilization. The median hospitalization charge was 8% lower for the break cohort, translating to around $500,000/year of decreased charges at our institution. Further research is required to understand the causal factors. A prospective experience is underway.