Evaluation of early hospital discharge after allogeneic bone marrow transplantation for chronic myeloid leukemia
Keywords:
Chronic myeloid leukemia, Bone marrow transplantation, Retrospective studies, Ambulatory care, Length of stayAbstract
CONTEXT AND OBJECTIVE: The increasing number of patients waiting for bone marrow transplantation in our service led to the implement of an early hospital discharge program with the intention of reducing the interval between diagnosis and transplantation. In this study we analyzed the results from early discharge, with outpatient care for patients with chronic myeloid leukemia who underwent allogeneic bone marrow transplantation. DESIGN AND SETTING: Retrospective study at the Bone Marrow Transplantation Unit of Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: We compared clinical outcomes within 100 days post-transplantation, for 51 patients with chronic myeloid leukemia (CML) who received partially outpatient-based allogeneic hematopoietic stem cell transplantation, and the results were compared with a historical control group of 49 patients who received inpatientbased hematopoietic stem cell transplantation. RESULTS: There were significantly fewer days of hospitalization (p = 0.004), Pseudomonas-positive cultures (p = 0.006) and nausea and vomiting of grade 2-3 (p < 0.001) in the outpatient group. There were no significant differences in mortality between the groups and no deaths occurred within the first 48 days post-transplantation in the outpatient group. CONCLUSIONS: This partially outpatient-based hematopoietic stem cell transplantation program allowed an increased number of transplantations in our institution, in cases of CML and other diseases, since it reduced the median length of hospital stay without increasing morbidity and mortality.
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References
Goldman JM, Druker BJ. Chronic myeloid leukemia: current treatment options. Blood. 2001;98(7):2039-42.
O’Dwyer ME. Chronic myelogenous leukemia. Curr Opin Oncol. 2003;15(1):10-5.
Maziarz RT, Mauro MJ. Transplantation for chronic myelog- enous leukemia: yes, no, maybe so... An Oregon perspective. Bone Marrow Transplant. 2003;32(5):459-69.
Peters WP, Ross M, Vredenburgh JJ, et al. The use of intensive clinic support to permit outpatient autologous bone marrow transplantation for breast cancer. Semin Oncol. 1994;21(4 Suppl 7):25-31.
Jagannath S, Vesole DH, Zhang M, et al. Feasibility and cost- effectiveness of outpatient autotransplants in multiple myeloma. Bone Marrow Transplant. 1997;20(6):445-50.
Freeman M, Vose J, Bennett C, et al. Costs of care associated with high-dose therapy and autologous transplantation for non-Hodgkin’s lymphoma: results from the University of Ne- braska Medical Center 1989 to 1995. Bone Marrow Transplant. 1999;24(6):679-84.
Mishra V, Vaaler S, Brinch L. Cost analysis of autologous pe- ripheral blood stem cell transplantation for multiple myeloma. Clin Lab Haematol. 2003;25(3):179-84.
Meisenberg BR, Ferran K, Hollenbach K, Brehm T, Jollon J, Piro LD. Reduced charges and costs associated with outpatient autologous stem cell transplantation. Bone Marrow Transplant. 1998;21(9):927-32.
Rizzo JD, Vogelsang GB, Krumm S, Frink B, Mock V, Bass EB. Outpatient-based bone marrow transplantation for hema- tologic malignancies: cost saving or cost shifting? J Clin Oncol. 1999;17(9):2811-8.
Westermann AM, Holtkamp MM, Linthorst GA, et al. At home management of aplastic phase following high-dose chemotherapy with stem-cell rescue for hematological and non- hematological malignancies. Ann Oncol. 1999;10(5):511-7.
Gonzalez-Ryan L, Haut PR, Coyne K, et al. Developing a pediatric outpatient transplantation program. The Children’s Memorial Hospital experience. Front Biosci. 2001;6:G1-5.
Frey P, Stinson T, Siston A, et al. Lack of caregivers limits use of outpatient hematopoietic stem cell transplant program. Bone Marrow Transplant. 2002;30(11):741-8.
Dix SP, Geller RB. High-dose chemotherapy with autologous stem cell rescue in the outpatient setting. Oncology (Williston Park). 2000;14(2):171-85; discussion 185-6, 191-2.
Russell JA, Chaudhry A, Booth K, et al. Early outcomes after allogeneic stem cell transplantation for leukemia and myelod- ysplasia without protective isolation: a 10-year experience. Biol Blood Marrow Transplant. 2000;6(2):109-14.
Ruiz-Arguelles GJ, Gomez-Almaguer D, Ruiz-Arguelles A, Gonzalez-Llano O, Cantu OG, Jaime-Perez JC. Results of an outpatient-based stem cell allotransplant program using nonmyeloablative conditioning regimens. Am J Hematol. 2001;66(4):241-4.
Svahn BM, Bjurman B, Myrback KE, Aschan J, Ringden O. Is it safe to treat allogeneic stem cell transplant recipients at home during the pancytopenic phase? A pilot trial. Bone Marrow Transplant. 2000;26(10):1057-60.
Svahn BM, Remberger M, Myrback KE, et al. Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared with hospital care. Blood. 2002;100(13):4317-24.
Gratwohl A, Hermans J, Goldman JM, et al. Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Lancet. 1998;352(9134):1087-92.
Lawrence CC, Gilbert CJ, Peters WP. Evaluation of symptom distress in a bone marrow transplant outpatient environment. Ann Pharmacother. 1996;30(9):941-5.
Summers N, Dawe U, Stewart DA. A comparison of in- patient and outpatient ASCT. Bone Marrow Transplant. 2000;26(4):389-95.
Svahn BM, Ringden O, Remberger M. Long-term follow-up of patients treated at home during the pancytopenic phase after allogeneic haematopoietic stem cell transplantation. Bone Mar- row Transplant. 2005;36(6):511-6.
Herrmann RP, Trent M, Cooney J, Cannell PK. Infections in patients managed at home during autologous stem cell trans- plantation for lymphoma and multiple myeloma. Bone Marrow Transplant. 1999;24(11):1213-7.
Egerer G, Goldschmidt H, Salwender H, et al. Efficacy of continu- ous infusion of ceftazidime for patients with neutropenic fever after high-dose chemotherapy and peripheral blood stem cell transplantation. Int J Antimicrob Agents. 2000;15(2):119-23.
Seropian S, Nadkarni R, Jillella AP, et al. Neutropenic infections in 100 patients with non-Hodgkin’s lymphoma or Hodgkin’s disease treated with high-dose BEAM chemotherapy and periph- eral blood progenitor cell transplant: out-patient treatment is a viable option. Bone Marrow Transplant. 1999;23(6):599-605.
