Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared with hospital care

Abstract

After myeloablative treatment and allogeneic stem cell transplantation (SCT), patients are kept in isolation rooms in the hospital to prevent neutropenic infections. During a 3-year period, patients were given the option of treatment at home after SCT. Daily visits by an experienced nurse and daily phone calls from a physician from the unit were included in the protocol. We compared 36 patients who wished to be treated at home with 18 patients who chose hospital care (control group 1). A matched control group of 36 patients treated in the hospital served as control group 2. All home care patients had hematologic malignancies and 19 were in first remission or first chronic phase. Of the donors, 25 were unrelated. The patients spent a median of 16 days at home (range, 0-26 days). Before discharge to the outpatient clinic after SCT, patients spent a median of 4 days (range, 0-39 days) in the hospital. In the multivariate analysis, the home care patients were discharged earlier (relative risk [RR] 0.33, P ‫؍‬ .03), had fewer days on total parenteral nutrition (RR 0.24, P < .01), less acute graft-versus-host disease (GVHD) grades II-IV (RR 0.25, P ‫؍‬ .01), lower transplantationrelated mortality rates (RR 0.22, P ‫؍‬ .04), and lower costs (RR 0.37, P < .05), compared with the controls treated in the hospital. The 2-year survival rates were 70% in the home care group versus 51% and 57% (not significant) in the 2 control groups, respectively (P < .03). To conclude, home care after SCT is a novel and safe approach. This study found it to be advantageous, compared with hospital care. (Blood. 2002;100: 4317-4324)

Performing allogeneic and autologous hematopoietic SCT in the outpatient setting: effects on infectious complications and early transplant outcomes

“…Recently van Tiel et al 11 published a review of six studies describing home care vs hospital care of patients with hematological malignancies after HSCT and suggested no benefit for protective isolation environments. In a unique approach Svahn et al (2002), 12 described a model in which treatment at home was provided for allo-HSCT during the pancytopenic phase. This study found home care advantageous compared with hospital care.…”

Home management of hematological patients requiring hospital admission

“…Even though this study was not performed to analyze costs for management of hematological patients, the HHS has already demonstrated economical advantages over traditional care in the management of elderly patients affected by stroke or chronic obstructive pulmonary disease (Ricauda et al, 2005;Aimonino Ricauda et al, 2008). The home treatment of patients during the post-transplant pancytopenic phase has been found cheaper than in-hospital treatment (Svahn et al, 2002). Cartoni et al (2007) demonstrated that the mean monthly cost for subjects with hematological illnesses are lower than the average costs that would have been charged to the National Health System in the event of hospitalization.…”

Unrelated cord blood and mismatched unrelated volunteer donor transplants, two alternatives in patients who lack an HLA-identical donor

“…All patients were kept in reversed isolation or treated at home 24 Between 1995 and 2000, G-CSF was given to 11 UCB patients and to 10 recipients of mismatched unrelated grafts, at a dose of 5 mg per day intravenously from day 10 until neutrophil engraftment 40.5 Â 10 9 /l for 2 days. After that, G-CSF prophylaxis was stopped because we found that it resulted in an increased incidence of acute GVHD of grades II-IV.…”

“…25 Supportive care has been described in detail previously, especially in BM recipients. 20,24 Chimerism analysis PCR amplification of variable numbers of tandem repeats was used to evaluate various degrees of donor and recipient chimerism in CD3 þ , CD19 þ and CD33 þ cells enriched from blood samples using immunomagnetic beads (Dynal, Oslo, Norway), as previously described. 26 Complete donor chimerism (DC) was defined as 495% donor cells.…”