Case-control comparison of at-home to total hospital care for autologous stem-cell transplantation for hematologic malignancies.
OBJECTIVE
One of the most significant limitations of at-home autologous stem-cell transplantation (ASCT) is the necessity for hospital readmission. We developed an at-home ASCT program in which prophylactic ceftriaxone and treatment of febrile neutropenia with piperacillin and tazobactam was introduced to minimize the readmission rate.


METHODS
Between November 2000 and February 2005, 178 consecutive patients underwent ASCT for a hematologic malignancy. Of these, 50 patients fulfilled the requirements for at-home ASCT. Results were compared with those observed in a control group of 50 patients individually matched to the group of patients treated at home for age, sex, diagnosis, stage of disease, conditioning, and source of stem cells.


RESULTS
Febrile neutropenia occurred in fewer patients in the at-home group as compared with the hospitalized group (76% v 96%: P = .008), and duration of fever was also shorter in the at-home group (median, 2 and 6 days, respectively; range, 1 to 11 and 1 to 20 days, respectively; P = .00003). Hospital readmission in the at-home group was required in only four cases (8%). This resulted in a reduction of 18.6 days of hospitalization per patient. Likewise, total median charges were approximately half in the at-home group as compared with the in-hospital group (3,345 euro v 6,250 euro, respectively; P < .00001).


CONCLUSIONS
Results of at-home ASCT with prophylactic administration of ceftriaxone and domiciliary treatment of febrile neutropenia with piperacillin and tazobactam are highly satisfactory and significantly cheaper compared with those obtained with conventional in-hospital ASCT.
Fernández-Avilés
Francesc
F
Department of Hematology, Institute of Hematology and Oncology, IDIBAPS, Postgraduate School of Hematology Farreras Valentí, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain. ffernand@clinic.ub.es
Carreras
Enric
E
Urbano-Ispizua
Alvaro
A
Rovira
Montserrat
M
Martínez
Carmen
C
Gaya
Anna
A
Granell
Miquel
M
Ramiro
Laia
L
Gallego
Cristina
C
Hernando
Adela
A
Segura
Susana
S
García
Lourdes
L
González
Manel
M
Valverde
Montserrat
M
Montserrat
Emili
E
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D002066:Busulfan / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000517:prevention & control; D017048:Health Care Costs / Q000706:statistics & numerical data; D019337:Hematologic Neoplasms / Q000628:therapy*; D006699:Home Care Services; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control; D010359:Patient Readmission / Q000706:statistics & numerical data; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D033581:Stem Cell Transplantation / Q000191:economics / Q000379:methods; D000078142:Tazobactam; D014182:Transplantation, Autologous
D000900:Anti-Bacterial Agents; D018906:Antineoplastic Agents, Alkylating; D002443:Ceftriaxone; D010397:Penicillanic Acid; D002066:Busulfan; D000078142:Tazobactam; D010878:Piperacillin