Originally published as JCO Early Release 10.1200/JCO.2006.06.4238 on September 25 2006

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

Francesc Fernández-Avilés, Enric Carreras, Alvaro Urbano-Ispizua, Montserrat Rovira, Carmen Martínez, Anna Gaya, Miquel Granell, Laia Ramiro, Cristina Gallego, Adela Hernando, Susana Segura, Lourdes García, Manel González, Montserrat Valverde, Emili Montserrat

From the Department of Hematology, Institute of Hematology and Oncology, IDIBAPS, Postgraduate School of Hematology Farreras Valentí, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain

Address reprint requests to Francesc Fernández-Avilés, MD, Institute of Haematology and Oncology, Hospital Clínic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; e-mail: ffernand{at}clinic.ub.es

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.

published online ahead of print at www.jco.org on September 25, 2006.

Supported by Grant No. RTICCC03/10 from Instituto de Salud Carlos III (ISCIII), Grant No. 2005SGR00825 from Generalitat de Catalunya, and an unrestricted grant from Schering (Madrid, Spain) and Roche (Madrid, Spain).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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