title: Hospital length of stay in the first 100 days after allogeneic hematopoietic cell transplantation for acute leukemia in remission: comparison among alternative graft sources.
abstract: Several studies have shown comparable survival outcomes with different graft sources, but the relative resource needs of hematopoietic cell transplantation (HCT) by graft source have not been well studied. We compared total hospital length of stay in the first 100 days after HCT in 1577 patients with acute leukemia in remission who underwent HCT with an umbilical cord blood (UCB), matched unrelated donor (MUD), or mismatched unrelated donor (MMUD) graft between 2008 and 2011. To ensure a relatively homogenous study population, the analysis was limited to patients with acute myelogenous leukemia and acute lymphoblastic leukemia in first or second complete remission who underwent HCT in the United States. To account for early deaths, we compared the number of days alive and out of the hospital in the first 100 days post-transplantation. For children who received myeloablative conditioning, the median time alive and out of the hospital in the first 100 days was 50 days for single UCB recipients, 54 days for double UCB recipients, and 60 days for MUD bone marrow (BM) recipients. In multivariate analysis, use of UCB was significantly associated with fewer days alive and out of the hospital compared with MUD BM. For adults who received myeloablative conditioning, the median time alive and out of the hospital in first 100 days was 52 days for single UCB recipients, 55 days for double UCB recipients, 69 days for MUD BM recipients, 75 days for MUD peripheral blood stem cell (PBSC) recipients, 63 days for MMUD BM recipients, and 67 days for MMUD PBSC recipients. In multivariate analysis, UCB and MMUD BM recipients had fewer days alive and out of the hospital compared with recipients of other graft sources. For adults who received a reduced-intensity preparative regimen, the median time alive and out of the hospital during the first 100 days was 65 days for single UCB recipients, 63 days for double UCB recipients, 79 days for MUD PBSC recipients, and 79 days for MMUD PBSC recipients. Similar to the other 2 groups, receipt of UCB was associated with a fewer days alive and out of the hospital. In conclusion, length of stay in the first 100 days post-transplantation varies by graft source and is longer for UCB HCT recipients. These data provide insight into the resource needs of patients who undergo HCT with these various graft sources.
authors: Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Karen K
authors: KK
authors: Ballen
authors: Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors: Steven
authors: S
authors: Joffe
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Ruta
authors: R
authors: Brazauskas
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Zhiwei
authors: Z
authors: Wang
authors: Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors: Mahmoud D
authors: MD
authors: Aljurf
authors: Department of Oncology, Banner M.D. Anderson Cancer Center, Gilbert, Arizona.
authors: Görgün
authors: G
authors: Akpek
authors: Department of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Christopher
authors: C
authors: Dandoy
authors: Department of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Haydar A
authors: HA
authors: Frangoul
authors: Hematopoietic Stem Cell Transplant Program, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors: César O
authors: CO
authors: Freytes
authors: Department of Hematology/Oncology, Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, Arizona.
authors: Nandita
authors: N
authors: Khera
authors: Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors: Hillard M
authors: HM
authors: Lazarus
authors: Hematology and Bone Marrow Transplant, Sarah Cannon, Nashville, Tennessee.
authors: Charles F
authors: CF
authors: LeMaistre
authors: Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Paulette
authors: P
authors: Mehta
authors: Department of Medicine and Pediatrics, Tufts Medical Center, Boston, Massachusetts.
authors: Susan K
authors: SK
authors: Parsons
authors: Department of Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: David
authors: D
authors: Szwajcer
authors: Divison of Hematology, Oncology and Transplantation, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors: Celalettin
authors: C
authors: Ustun
authors: Department of Hematology/Oncology, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors: William A
authors: WA
authors: Wood
authors: Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio. Electronic address: majhain@ccf.org.
authors: Navneet S
authors: NS
authors: Majhail
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
keywords: Hematopoietic cell transplantation; Length of stay; Leukemia; Resource utilization; Umbilical cord blood