title: Many days at home during neutropenia after allogeneic hematopoietic stem cell transplantation correlates with low incidence of acute graft-versus-host disease.
abstract: Patients are isolated in the hospital during the neutropenic phase after allogeneic hematopoietic stem cell transplantation. We challenged this by allowing patients to be treated at home. A nurse from the unit visited and checked the patient. One hundred forty-six patients treated at home were compared with matched hospital control subjects. Oral intake was intensified from September 2006 and improved (P = .002). We compared 4 groups: home care and control subjects before and after September 2006. The cumulative incidence of acute graft-versus-host disease (GVHD) of grades II to IV was 15% in the "old" home care group, which was significantly lower than that of 32% to 44% in the other groups (P < .03). Transplantation-related mortality, chronic GVHD, and relapse were similar in the groups. The "new" home care patients spent fewer days at home (P = .002). In multivariate analysis, GVHD of grades 0 to I was associated with home care (hazard ratio [HR], 2.46; P = .02) and with days spent at home (HR, .92; P = .005) but not with oral nutrition (HR, .98; P = .13). Five-year survival was 61% in the home care group as compared with 49% in the control subjects (P = .07). Home care is safe. Home care and many days spent at home were correlated with a low risk of acute GVHD.
authors.affiliation: Division of Clinical Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. Olle.Ringden@ki.se
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
authors.forename: Katarina
authors.initials: K
authors.lastname: Holmberg
authors.forename: Charlotta
authors.initials: C
authors.lastname: Edeskog
authors.forename: Marie
authors.initials: M
authors.lastname: Wikström
authors.forename: Britta
authors.initials: B
authors.lastname: Eriksson
authors.forename: Sigrun
authors.initials: S
authors.lastname: Finnbogadottir
authors.forename: Karin
authors.initials: K
authors.lastname: Fransson
authors.forename: Ruza
authors.initials: R
authors.lastname: Milovsavljevic
authors.forename: Brigitta
authors.initials: B
authors.lastname: Omazic
authors.forename: Petter
authors.initials: P
authors.lastname: Svenberg
authors.forename: Jonas
authors.initials: J
authors.lastname: Mattsson
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Svahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood* / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology* / Q000276:immunology; D014184:Transplantation, Homologous; D055815:Young Adult