Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared with hospital care.
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 transplantation-related 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.
Svahn
Britt-Marie
BM
Centre for Allogeneic Stem Cell Transplantation, Department of Clinical Immunology, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden. b-m.svahn@transpl.hs.sll.se
Remberger
Mats
M
Myrbäck
Karl-Erik
KE
Holmberg
Katarina
K
Eriksson
Britta
B
Hentschke
Patrik
P
Aschan
Johan
J
Barkholt
Lisbeth
L
Ringdén
Olle
O
D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D002423:Cause of Death; D003365:Costs and Cost Analysis; D016572:Cyclosporine / Q000627:therapeutic use; D004363:Drug Utilization; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000209:etiology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006701:Home Nursing / Q000191:economics / Q000523:psychology; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017053:Infection Control; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010198:Pancytopenia / Q000628:therapy*; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D010348:Patient Care Team; D010356:Patient Isolation; D011239:Prednisolone / Q000627:therapeutic use; D011788:Quality of Life; D012008:Recurrence; D015996:Survival Rate; D013548:Sweden; D019172:Transplantation Conditioning / Q000009:adverse effects; D016896:Treatment Outcome
D000700:Analgesics; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D008727:Methotrexate