Improving timely melphalan administration completion for recipients of autologous stem cell transplant.

• DOI: 10.1200/op.2023.19.11_suppl.372
• Publication Date: 2023-10-26T13:03:34Z
• Authors: Michael Williams; Brittany Mejaki; Sol Atienza; Renee Aranda; Justin Graff; Mark Hamm; Stephen Medlin
• Keywords: Melphalan; Vial

372 Background: Melphalan hydrochloride is a primary agent used in the conditioning regimen for autologous stem cell transplant indications including multiple myeloma and lymphoma. Brand Alkeran labelling indicates drug concentration must not exceed 0.45 mg/mL should be given over minimum 15 minutes but infused its entirety within 60 from preparation. Caution provided as data has shown loss of potency by 1% every 10 after melphalan dilution. Time constraints often require dose being divided into two infusion bags with option to Y-site. These limitations necessitated an optimized process ensure completion 60-minute timeframe. Methods: Our institution began formally audit administration November 2018 part new program quality metric. A retrospective evaluation was performed which assessed total time dilution normal saline (NS) bag completion. The aim increase compliance 86.2% 100%. We utilized Plan-Do-Study-Act (PDSA) cycle method address opportunities improvement. PDSA 1 included staff education on importance timely administration; same-day forms were created dissect any potential fallouts promptly. This form documentation vial reconstitution delivery pharmacist patient care unit. Secondary re-evaluation package insert verbiage discussion manufacturer, we redefined start instead bag. 2 incorporated specific checkpoints (12 minutes) (20 changed concurrent sequential administration. Results: 285 infusions eligible analysis (mean 1.91 per patient). Baseline showed completed Average time-to-completion 50.2 (N=73). revealed 100% chemotherapy verification 97.9% average 42.8 (N=97). resulted 99.1% (one fallout) 41.2 (N=115). Overall survival (OS) at 1-year baseline, 1, groups 94.7%, 95.9%, 98.3% respectively ( p=0.66). Conclusions: outcome measure mean improved minutes, respectively, secondary implementation despite more stringent time. lone fallout 62 triaged determined due unpredictable line complications. No significant differences OS observed. Ultimately, our terms both efficiency.