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Prepublished online as a Blood First Edition Paper on August 22, 2002; DOI 10.1182/blood-2002-03-0801.
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Blood, 15 December 2002, Vol. 100, No. 13, pp. 4317-4324
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Home care during the pancytopenic phase after allogeneic
hematopoietic stem cell transplantation is advantageous compared with
hospital care
Britt-Marie Svahn,
Mats Remberger,
Karl-Erik Myrbäck,
Katarina Holmberg,
Britta Eriksson,
Patrik Hentschke,
Johan Aschan,
Lisbeth Barkholt, and
Olle Ringdén
From the Centre for Allogeneic Stem Cell
Transplantation, Departments of Clinical Immunology and Hospital
Infection Control, Hematology, Karolinska Institutet, Huddinge
University Hospital, Stockholm, Sweden.
After myeloablative treatment and allogeneic stem cell
transplantation (SCT), patients are kept in isolation rooms in the hospital to prevent neutropenic infections. During a 3-year period, patients were given the option of treatment at home after SCT. Daily
visits by an experienced nurse and daily phone calls from a physician
from the unit were included in the protocol. We compared 36 patients
who wished to be treated at home with 18 patients who chose hospital
care (control group 1). A matched control group of 36 patients treated
in the hospital served as control group 2. All home care patients had
hematologic malignancies and 19 were in first remission or
first chronic phase. Of the donors, 25 were unrelated. The patients
spent a median of 16 days at home (range, 0-26 days). Before discharge
to the outpatient clinic after SCT, patients spent a median of
4 days (range, 0-39 days) in the hospital. In the multivariate
analysis, the home care patients were discharged earlier (relative risk
[RR] 0.33, P = .03), had fewer days on total
parenteral nutrition (RR 0.24, P < .01), less acute graft-versus-host disease (GVHD) grades II-IV (RR 0.25, P = .01), lower transplantation-related
mortality rates (RR 0.22, P = .04), and lower costs (RR
0.37, P < .05), compared with the controls treated in
the hospital. The 2-year survival rates were 70% in the home care
group versus 51% and 57% (not significant) in the 2 control
groups, respectively (P < .03). To conclude, home care
after SCT is a novel and safe approach. This study found it to be
advantageous, compared with hospital care.
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