 Leukemia & Lymphoma, July 2014; 55(7): 1657–1660 © 2014 Informa UK, Ltd. ISSN: 1042-8194 print / 1029-2403 online DOI: 10.3109/10428194.2013.842989 Correspondence: Dr. Attilio Olivieri, Department of Hematology, Ospedali Riuniti di Ancona, Ancona, Italy. Tel: + 39-0715964226. Fax + 39-0715964222. E-mail: olivieri@univpm.it Received 12 July 2013; revised 28 August 2013; accepted 5 September 2013 LETTER TO THE EDITOR Conditioning regimen with BCNU, etoposide, cytarabine and melphalan plus amifostine for outpatient autologous stem cell transplant: feasibility and outcome in 97 patients with lymphoma Ilaria Scortechini 1 , Mauro Montanari 1 , Giorgia Mancini 1 , Elena Inglese 1 , Monica Calandrelli 1 , Martina Chiarucci 1 , Massimo Offidani 1 , Debora Capelli 1 , Guido Gini 1 , Antonella Poloni 1 , Stefania Mancini 1 , Gianmario Raggetti 2 , Pietro Leoni 1 & Attilio Olivieri 1 1 Department of Hematology, Ospedali Riuniti di Ancona, Ancona, Italy and 2 Department of Economics, Università Politecnica delle Marche, Ancona, Italy BEAM (BCNU, etoposide, cytarabine, melphalan) is standard conditioning for autologous stem cell transplant (ASCT) in Hodgkin disease (HD) and in non-Hodgkin lymphoma (NHL) [1]. Growth factors (GFs) and peripheral blood pro- genitor cells (PBSCs) reduce febrile neutropenia, but do not abrogate infections and prolonged hospitalization. Several models of ASCT in an outpatient setting have been developed, particularly in multiple myeloma [2], but few experiences have been reported in patients with lymphoma. Te major non-hematological toxicity limiting an outpa- tient approach in this setting remains severe mucositis [3]. Amifostine before high-dose melphalan (HDM) can reduce severe mucositis and the duration of analgesic therapy [4]; therefore, we prospectively evaluated the feasibility of an outpatient ASCT program with BEAM-amifostine (BEAaM) in patients with lymphoma. We consecutively observed 97 patients with lymphoma, candidate for ASCT (details in Table I). Te primary end point was the feasibility of an outpatient ASCT program with BEAaM conditioning. Secondary end points were cost estimation and ASCT outcome. Inclusion criteria were: Age 18–75 years; • Diagnosis of NHL/HD; • World Health Organization (WHO) performance • status 0–1; No severe comorbidities; • Available family caregiver; • Estimated time to reach transplant unit •  40 min; Compliance to home therapy; • No previous infection with multiresistant bacteria or • fungi. Tose patients ( n = 33) not meeting these inclusion criteria received the same conditioning (BEaAM) and were managed in hospital during the aplastic phase, with similar supportive care, up to stable and complete engraftment. Te outpatient transplant program was scheduled as follows: conventional hospital stay during conditioning regimen; discharge after PBSC infusion (day + 1); home stay during aplastic phase with a family caregiver (patients presented twice weekly for check-up at the transplant unit); home nursing was not arranged, but patients had a direct phone line connection with the transplant unit in case of emergency. Patients, gen- eral practitioners and caregivers received appropriate train- ing regarding home behavior and management of mucositis, fever or mucosal bleeding. Te BEAM schedule [1] was modifed by adding amifos- tine at 740 mg/m 2 IV, before HDM, as previously published [4]. Both the 64 patients managed on an outpatient basis and the 33 patients managed in hospital received the same antimicrobial prophylaxis, but while the in-hospital group received flgrastim 5 μg/kg/day from day + 1 until hematopoi- etic recovery, the 64 patients discharged at day + 1 received pegflgrastim 6 mg, single injection at day + 1. A second hospitalization was planned in the case of: severe mucositis (WHO grade 3–4) needing parenteral nutrition and/or narcotic analgesics; neutropenic fever (NF) unresponsive to oral amoxicillin 1 g twice daily orally; NF with hypotension; any other severe adverse efects need- ing to be managed in hospital. We also performed a cost analysis by evaluating both direct and indirect costs; both the indirect and the direct costs of resources employed and the professional fees were derived from our hospital analytic accounting system. Sixty-four patients (66%) met the inclusion criteria for outpatient ASCT and entered the protocol (these patients were discharged at day + 1), while 33 (34%) did not fulfll the inclusion criteria, due to (Figure 1): comorbidities ( n = 9); estimated time to reach transplant unit  40 min ( n = 7);