Is it safe to treat allogeneic stem cell transplanted recipients at home during the pancytopenic phase? A pilot trial.
BACKGROUND
After myeloablative treatment and allogeneic stem cell transplantation (ASCT), patients are kept isolated in the hospital to prevent infections during neutropenia.


METHODS
So far, 22 patients have been given the choice of being treated at home. Eleven could not be treated at home, and they served as controls. Most of them had haematological malignancies. The donors were 12 HLA-compatible unrelated, 9 HLA-identical siblings and one twin.


RESULTS
In the home care group, 3 developed bacteraemia, compared to 9 in the controls (p<0.01). The patient in the home care group had fewer days on total parenteral nutrition (median 3 vs. 24, p<0.001), required fewer erythrocyte transfusions (median 4 vs. 8, p=0.01), fewer days on i.v. antibiotics (median 6 vs. 13 days), and on analgesics (median 0 vs. 15) than the controls (p<0.05). Days with fever, time to engraftment, days with G-CSF and acute GVHD were the same in the two groups. 7/11 patients treated at home were readmitted to the ward for median 3 (0-7) days, due to fever or lack of a caregiver at home. Days to discharge to the out-patient clinic was faster in the group treated at home (median 20 vs 35 days, p<0.01).


CONCLUSIONS
Patients who were treated at home enjoyed being active and taking a walk when they felt like it. This preliminary report suggests that home care after ASCT is not only safe, but better than isolation in the hospital.
Svahn
B-M
BM
Centre for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Huddinge Hospital B87, SE-141 86 Huddinge, Sweden. Britt-Marie.Svahn@transpl.hs.sll.se
Bjurman
B
B
Myrbäck
K-E
KE
Aschan
J
J
Ringdén
O
O
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016465:Bone Marrow Purging / Q000009:adverse effects / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005335:Fever of Unknown Origin / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D009894:Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010198:Pancytopenia / Q000139:chemically induced* / Q000150:complications; D010356:Patient Isolation / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D010865:Pilot Projects; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013557:Switzerland
D000970:Antineoplastic Agents