BACKGROUND: Acute graft-versus-host disease (GVHD) was reduced using home care compared with hospital care after allogeneic hematopoietic stem-cell transplantation (ASCT). METHODS: Between March 1998 and December 2006, 601 patients underwent ASCT at our unit. Requirements for at-home ASCT were fulfilled by 76 patients. A control group of 76 patients treated in the hospital were matched for age, sex, diagnosis, stage of disease, conditioning, stem-cell source, type of donor, and immunosuppression. Oral nutrition was determined as median kcal/kg/day for the first 21 days after ASCT. RESULTS: The home-care patients received more oral nutrition per day than hospital controls (P<0.05). Number of days at home correlated with oral nutrition (P=0.004). In multivariate analysis, acute GVHD of grades II to IV was associated with poor oral nutrition (P=0.003) and hospital care (P=0.06). Transplant-related mortality was associated with acute GVHD grades II to IV (P<0.0001) and bacteremia (P=0.004). In addition to acute GVHD and bacteremia, death was associated with absence of chronic GVHD (P=0.012). Five-year survival was 65% in patients treated at home, when compared with 47% in the controls (P=0.04). CONCLUSION: Better oral nutrition may be one reason for the reduced probability of acute GVHD and better survival with at-home care than with hospital care.
BACKGROUND: Acute graft-versus-host disease (GVHD) was reduced using home care compared with hospital care after allogeneic hematopoietic stem-cell transplantation (ASCT). METHODS: Between March 1998 and December 2006, 601 patients underwent ASCT at our unit. Requirements for at-home ASCT were fulfilled by 76 patients. A control group of 76 patients treated in the hospital were matched for age, sex, diagnosis, stage of disease, conditioning, stem-cell source, type of donor, and immunosuppression. Oral nutrition was determined as median kcal/kg/day for the first 21 days after ASCT. RESULTS: The home-care patients received more oral nutrition per day than hospital controls (P<0.05). Number of days at home correlated with oral nutrition (P=0.004). In multivariate analysis, acute GVHD of grades II to IV was associated with poor oral nutrition (P=0.003) and hospital care (P=0.06). Transplant-related mortality was associated with acute GVHD grades II to IV (P<0.0001) and bacteremia (P=0.004). In addition to acute GVHD and bacteremia, death was associated with absence of chronic GVHD (P=0.012). Five-year survival was 65% in patients treated at home, when compared with 47% in the controls (P=0.04). CONCLUSION: Better oral nutrition may be one reason for the reduced probability of acute GVHD and better survival with at-home care than with hospital care.
Authors: Gonzalo Gutiérrez-García; Montserrat Rovira; Nacira Arab; Cristina Gallego; Joan Sánchez; María Ángeles Álvarez; Pilar Ayora; Ariadna Domenech; Nuria Borràs; Luis Gerardo Rodríguez-Lobato; Laura Rosiñol; Pedro Marín; Alexandra Pedraza; Alexandra Martínez-Roca; Esther Carcelero; María Dolores Herrera; María Teresa Solano; Carla Ramos; Noemí de Llobet; Anna Serrahima; Miquel Lozano; Joan Cid; Carmen Martínez; María Suárez-Lledó; Álvaro Urbano-Ispizua; Francesc Fernández-Avilés Journal: Bone Marrow Transplant Date: 2020-01-13 Impact factor: 5.483
Authors: Karin Bergkvist; Jeanette Winterling; Eva Johansson; Unn-Britt Johansson; Britt-Marie Svahn; Mats Remberger; Jonas Mattsson; Joacim Larsen Journal: Support Care Cancer Date: 2014-10-17 Impact factor: 3.603