Case-Control Comparison of At-Home to Total Hospital Care for Autologous Stem-Cell Transplantation for Hematologic Malignancies

2006 ◽  
Vol 24 (30) ◽  
pp. 4855-4861 ◽  
Author(s):  
Francesc Fernández-Avilés ◽  
Enric Carreras ◽  
Alvaro Urbano-Ispizua ◽  
Montserrat Rovira ◽  
Carmen Martínez ◽  
...  
Keyword(s):  
Stem Cell ◽  
Febrile Neutropenia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Hospital Readmission ◽  
Hematologic Malignancy ◽  
Control Group ◽  
Home Group ◽  
At Home

Purpose One of the most significant limitations of at-home autologous stem-cell transplantation (ASCT) is the necessity for hospital readmission. We developed an at-home ASCT program in which prophylactic ceftriaxone and treatment of febrile neutropenia with piperacillin and tazobactam was introduced to minimize the readmission rate. Patients and Methods Between November 2000 and February 2005, 178 consecutive patients underwent ASCT for a hematologic malignancy. Of these, 50 patients fulfilled the requirements for at-home ASCT. Results were compared with those observed in a control group of 50 patients individually matched to the group of patients treated at home for age, sex, diagnosis, stage of disease, conditioning, and source of stem cells. Results Febrile neutropenia occurred in fewer patients in the at-home group as compared with the hospitalized group (76% v 96%: P = .008), and duration of fever was also shorter in the at-home group (median, 2 and 6 days, respectively; range, 1 to 11 and 1 to 20 days, respectively; P = .00003). Hospital readmission in the at-home group was required in only four cases (8%). This resulted in a reduction of 18.6 days of hospitalization per patient. Likewise, total median charges were approximately half in the at-home group as compared with the in-hospital group (3,345 € v 6,250 €, respectively; P < .00001). Conclusion Results of at-home ASCT with prophylactic administration of ceftriaxone and domiciliary treatment of febrile neutropenia with piperacillin and tazobactam are highly satisfactory and significantly cheaper compared with those obtained with conventional in-hospital ASCT.

scholarly journals Strategies to upgrade safety for at-home autologous stem cell transplantation in multiple myeloma patients.

2020 ◽  
Author(s):  
Luis Gerardo Rodríguez-Lobato ◽  
Alexandra Martínez-Roca ◽  
Sandra Castaño-Díez ◽  
Alicia Palomino-Mosquera ◽  
Gonzalo Gutiérrez-García ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Hospital Readmissions ◽  
Primary Prophylaxis ◽  
Outpatient Setting ◽  
The Impact ◽  
At Home

Abstract Background. Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT.Methods. Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning + 1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT.Results. The incidence of NF among the groups was reduced (64%, 44%, and 24%; P < 0.001), with a non-significant decrease in hospital readmissions as well (12%, 6%, and 2%; P = 0.07). The most important variables identified for NF were: HCT-CI > 2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P < 0.001); and for hospital readmission: age ≥ 60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05).Conclusions. G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT.

scholarly journals Interleukin-2 after autologous stem cell transplantation for hematologic malignancy: a phase I/II study

1997 ◽  
Vol 19 (5) ◽  
pp. 435-442 ◽  
Author(s):  
N Robinson ◽  
MC Benyunes ◽  
JA Thompson ◽  
A York ◽  
S Petersdorf ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Phase I ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Hematologic Malignancy ◽  
Interleukin 2

scholarly journals At-home autologous stem cell transplantation in multiple myeloma with and without G-CSF administration: a comparative study

2015 ◽  
Vol 51 (4) ◽  
pp. 593-595 ◽  
Author(s):  
N Martínez-Cibrian ◽  
L Magnano ◽  
G Gutiérrez-García ◽  
X Andrade ◽  
J G Correa ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Comparative Study ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
At Home

Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared with hospital care

Blood ◽  
2002 ◽  
Vol 100 (13) ◽  
pp. 4317-4324 ◽  
Author(s):  
Britt-Marie Svahn ◽  
Mats Remberger ◽  
Karl-Erik Myrbäck ◽  
Katarina Holmberg ◽  
Britta Eriksson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Home Care ◽  
Cell Transplantation ◽  
Hospital Care ◽  
Group Versus ◽  
Control Group ◽  
Hematopoietic Stem ◽  
Phone Calls ◽  
At Home

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.

Pegfilgrastim Shows Safety and Efficacy Similar to Filgrastim in Patients Undergoing Autologous Stem Cell Transplantation for Hematological Malignancies.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1156-1156
Author(s):  
Peter Neumeister ◽  
Robert Holub ◽  
Phillipe B. Staber ◽  
Werner Linkesch
Keyword(s):  
Stem Cell ◽  
Febrile Neutropenia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Subcutaneous Injection ◽  
Hematological Malignancies ◽  
Infectious Complications ◽  
Safety And Efficacy ◽  
Single Subcutaneous Injection

Abstract Infectious complications are frequent events in patients undergoing high dose cytotoxic chemotherapy with subsequent autologous hematopoietic stem cell transplantation. In order to determine whether a single subcutaneous injection of pegfilgrastim (6mg) is as safe and effective as daily filgrastim (5mcg/kg/d) for reducing duration of grade 4 neutropenia and infectious complications, 60 consecutive autologous stem cell transplantations (ASCT) performed for various hematological malignancies have been analyzed retrospectively at our institution. 24 patients undergoing 30 consecutive ASCT received a single subcutaneous injection of 6 mg pegfilgrastim on day 5 after transplantation and were compared retrospectively to 30 patients receiving 5mcg/kg/d of filgrastim starting from day 7 post-transplantation. Both patient cohorts were comparable with respect to baseline patient and transplant characteristics. Duration of grade 4 neutropenia, infectious complications including incidence of febrile neutropenia, microbiological surveillance data and safety parameters were assessed. The mean duration of grade 4 neutropenia in the pegfilgrastim and filgrastim groups was 8.3 and 9.5 days, respectively (p=0,058). The results of the two groups were also not significantly different for febrile neutropenia, time to neutrophil recovery and toxicity profile, including bone pain episodes. However, a higher incidence of infectious complications associated with the filgrastim vs the pegfilgrastim group could be observed (50% vs 20%) (p=0,011). Pegfilgrastim was safe and well tolerated in this patient population. A single injection of pegfilgrastim administered at day 5 post-transplant shows comparable safety and efficacy profiles to that provided by daily injections of filgrastim. A fixed-dose pegfilgrastim facilitates the management of aplasia following autologous stem cell transplantation and may offer significant benefits for patients and health care providers. Consequently, it may serve as an attractive alternative to a repetitive single G-CSF administration modus. However, prospective randomized studies are warranted to corroborate the results obtained by this retrospective analysis.

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