Evaluation of early hospital discharge after allogeneic bone marrow transplantation for chronic myeloid leukemia

Abstract

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 inpatient-based 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.

Hospital and outpatient models for Hematopoietic Stem Cell Transplantation: A systematic review of comparative studies for health outcomes, experience of care and costs

“…With respect to the acute incidence of transplant rejection or GVHD, it has been reported to be significantly lower in the home modality [ 8 ]. Once again, similar incidence has also been reported in the two models of care [ 24 , 29 , 30 , 37 ]. The higher frequency of oral nutrition in the outpatient model has been associated with lower probability of GVHD [ 31 ].…”

“…Numerous studies show the frequency of neutropenic fever, the appearance of mucositis and the frequency of infections to be lower in the outpatient option [ 17 , 25 , 27 , 32 ], although there have also been studies reporting no differences [ 35 ]. The higher frequency of oral nutrition in the outpatient model has been associated with lower probability of side effects [ 29 ], which is in line with results from other clinical trials [ 41 , 42 ]. Furthermore, Owatanapach et al [ 7 ] found that patients who underwent a HSCT in an outpatient setting actually had a significantly lower risk of developing infectious complications, including 56% reduced odds of developing febrile neutropenia and 60% reduced odds of developing septicemia.…”

“…For allogeneic patients ( Table 6 ), the rates of mortality without recurrence of the disease at one year are similar when comparing inpatient and outpatient models [ 5 , 19 , 29 , 30 ] for allogeneic HCST. Lower mortality at 100 days time [ 4 ] and at 5 years time [ 31 ] has also been reported.…”

Infection‐related mortality after HLA‐identical and haploidentical hematopoietic cell transplantation using reduced‐intensity conditioning in an outpatient setting

“…Our transplant program is conducted in an ambulatory basis since its beginning 20 years ago 12 ; numerous studies have demonstrated lower infectious complications in patients undergoing HCT on an outpatient setting. [30][31][32] This study observed similar IRM rates compared to other centers performing inpatient HCT. Nonetheless, our patients admitted to the ICU had a higher risk of IRM, as shown in the multivariate analysis.…”

Insights from Brazilian medical journals

“…43 In another study, by reducing the median length of hospital stay without increasing morbidity and mortality a promising new hematopoietic stem cell transplantation program allowed an increment in the number of transplantations. 44 …”