Safe early discharge for patients undergoing high dose chemotherapy with or without stem cell transplantation: a prospective analysis of clinical variables predictive for complications after treatment.
OBJECTIVE
To identify which patient groups can be safely discharged early after high dose chemotherapy.


BACKGROUND
Until recently, the standard of care for patients with haematological malignancies who have been treated with high dose chemotherapy has been to hospitalise them until neutrophil recovery and clinical improvement. Over the past years, a more liberal approach has resulted in a tendency to discharge patients earlier. However, currently it is unclear which clinical variables are important and which patient groups are most suitable to be discharged early.


METHODS
Prospective cohort study.


METHODS
The study group of 55 patients underwent 82 admission periods for a total of 2269 patient days, which could be classified into four categories: induction treatment, consolidation treatment and autologous or allogeneic stem cell transplantation. Different clinical variables potentially interfering with early discharge were subsequently analysed for their association with each treatment group.


RESULTS
The median duration of admission was 27 days. The incidence of fever (82.9%) and use of intravenous antibiotics (79.3%) was high in all treatment groups. The only statistically significant differences between groups were found for performance status and mucositis. In the patient group undergoing consolidation chemotherapy for acute myeloid leukaemia, the performance status was better and mucositis was less severe. The decline in performance status and the severity of mucositis were as expected most obvious 10-14 days after the start of chemotherapy.


CONCLUSIONS
Patients undergoing consolidation chemotherapy appear to be the most suitable candidates for early discharge, especially in the first-week postchemotherapy treatment. Early discharge can also be considered in patients with a good performance status in the autologous stem cell transplantation group, directly after transplantation.


CONCLUSIONS
An important factor in developing an early discharge programme is a good infrastructure, both at home and in the hospital.
Department of Hematology, Academic Medical Centre, Amsterdam, the Netherlands. a.p.mank@amc.uva.nl
Arno
A
Mank
Johannes
J
van der Lelie
Rien
R
de Vos
Marie Jóse
MJ
Kersten
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000453:epidemiology; D009369:Neoplasms / Q000451:nursing / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D009503:Neutropenia / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D033581:Stem Cell Transplantation / Q000009:adverse effects*
D000900:Anti-Bacterial Agents