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Prepublished online as a Blood First Edition Paper on August 22, 2002; DOI 10.1182/blood-2002-03-0801.
Submitted March 14, 2002
Accepted July 15, 2002
Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared to hospital care
Britt-Marie Svahn*, Mats Remberger, Karl-Erik Myrback, Katarina Holmberg, Britta Eriksson, Patrik Hentschke, Johan Aschan, Lisbeth Barkholt, and Olle Ringden
Centre for Allogenic Stem Cell Transplantation, Huddinge University Hospital, Stockholm, Sweden
Centre for Allogenic Stem Cell Transplantation, Huddinge University Hospital, Stockholm, Sweden; Department of Clinical Immunology, Huddinge University Hospital, Stockholm, Sweden
Hospital Infection Control, Huddinge University Hospital, Stockholm, Sweden
Centre for Allogenic Stem Cell Transplantation, Huddinge University Hospital, Stockholm, Sweden; Department of Hematology, Huddinge University Hospital, Stockholm, Sweden
* Corresponding author; email: b-m.svahn{at}transpl.hs.sll.se.
After myeloablative treatment and allogeneic stem cell transplantation (SCT), patients are kept in isolation rooms in the hospital to prevent neutropenic infections. During a three-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 to 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 hematological 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 (0-26). Before discharge after SCT to the outpatient clinic, they spent a median of 4 (0-39) days in the hospital. In the multivariate analysis, the home care patients were discharged earlier (RR 0.33, p=0.03), had fewer days on total parenteral nutrition (RR 0.24, p<0.01), less acute GVHD grades II-IV (RR 0.25, p=0.01), lower transplant-related mortality rates (RR 0.22, p=0.04), and lower costs (RR 0.37, p<0.05), compared to the controls treated in the hospital. The two-year survival rates were 70% in the home care group vs. 51% and 57% (ns) in the two control groups, respectively (p<0.03). To conclude, home care after SCT is a novel and safe approach. This study found it to be advantageous, compared to hospital care.
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