At-Home Allogeneic Stem Cell Transplantation: A Single Centre Experience

INTRODUCTION:

Hospital-at-home (HAH) programs have significantly spread out in the last years and have demonstrated to improve patients satisfaction, avoid unnecessary hospital admissions and reduce healthcare costs. Allogeneic stem cell transplantation (allo-SCT) is a complex procedure with potential severe complications, including infections, mucositis and graft versus host disease (GVHD). However, previous reports have demonstrated that at-home allo-SCT is safe and feasible (Gutierrez-García et al. BMT 2019).

METHODS:

This is a retrospective analysis of patients treated with allo-SCT in at-home modality in our centre between 2021 and 2024.

Patients were included in the program if their residences were within a 30-minutes drive from our hospital and a caregiver was available at home 24 hours a day.

Patients were planned to be admitted to the SCT unit to receive as inpatient the conditioning regimen, stem cells infusion and post-transplant cyclophosphamide on days +3 and +4. After that, they were programmed to be discharged on day +5 in case of clinical and analytical stability, to continue with at-home follow up.

During the admission in the HAH unit, patients remained at home and were visited by nurses on a daily basis for clinical monitoring, blood samples collection, line care, intravenous drugs administration and platelet transfusions, among other activities. Additionally, patients received regular phone calls from nurses and physicians and 24 hours on-call medical coverage was ensured.

Antimicrobial prophylaxis was performed with oral levofloxacin 500 mg qd, posaconazole 300 mg qd and acyclovir 800 mg bid and intravenous ertapenem 1g qd.

Patients were re-admitted in case of severe refractory mucositis, persistent febrile neutropenia or due to physician decision and finally left the at-home program when stable engraftment was achieved and major complications were solved.

RESULTS:

Nine at-home allo-SCT were analysed. Five patients (55%) were female with a median age of 36 years (range 21-62). Diagnosis were: acute myeloid leukemia (n=3), non-Hodgkin lymphoma (n=2), Hodgkin lymphoma (n=1), acute lymphoblastic leukemia (n=1), chronic myeloid leukemia (n=1) and myelodysplastic syndrome (n=1). Donors were haploidentical (n=4), MSD (n=1), MUD (n=3) and MMUD (n=1). Eight patients (88%) received reduce intensity conditioning regimen. Patients were discharged from SCT unit at a median time of 6 days after transplant (range 5-8). Five patients (55%) developed grade 1 oral mucositis. No cases of severe bleeding, invasive fungal infection or multidrug resistance bacteria infections were diagnosed. Neutrophil and platelet engraftment were achieved at a median time of 14 days (range 12-19) and 14 days (range 11-29) after transplant, respectively. All patients received prophylactic platelet transfusions at-home, with no severe transfusion reactions. Seven patients (77%) completed the entire procedure in the outpatient setting and the remaining 2 patients needed readmission before engraftment (both of them due to febrile neutropenia). None of these patients needed admission in the intensive care unit. No cases of grade II-V acute GVHD were diagnosed. Median duration of the admission in HAH unit was 11 days (range 2-21).

CONCLUSIONS:

In our experience, at-home allo-SCT is a reproducible and safe procedure. The rate of readmission was low which was associated to a significant avoidance of days of admission in the SCT unit. In this sense, this study highlights the relevance of expanding at-home programs to avoid unnecessary admissions among other potential benefits.