by Dr. C.H. Weaver M.D. updated 4/2019
According to an article published in the Journal of Clinical Oncology, out patient or at-home autologous stem cell transplant (ASCT) reduces medical cost and hospital stay among patients with hematologic (blood) malignancies.
Stem cell transplantation is a commonly used treatment for NHL, particularly intermediate or aggressive NHL. This procedure includes the use of high doses of therapy to kill more cancer cells than standard doses. However, the high doses also destroy normal cells, such as blood cells. The destruction of blood cells, particularly immune cells, red blood cells, and platelets, can lead to life-threatening side effects.
To compensate for the low and dangerous levels of blood cells following high-dose therapy, patients receive hematopoietic stem cells, or immature blood cells. These stem cells mature into the three types of blood cells. In an autologous stem cell transplant, the patient’s own stem cells are collected prior to high-dose therapy and then re-infused following therapy.
As side effects due to autologous stem cell transplants are becoming more treatable and tolerable, researchers are focusing on ways to safely provide the procedure at home. Since hospital re-admission is a limitation of at-home autologous stem cell transplants, researchers continue to evaluate ways minimize risks of side effects caused by an autologous stem cell transplant so that patients can safely be treated at home without a high rate of hospital re-admission.
Researchers from Spain recently conducted a clinical trial to evaluate at-home autologous stem cell transplants in 50 patients with hematologic malignancies. The patients were treated with the preventive agent ceftriaxone to reduce the risk of low levels of immune cells accompanied by fever, as well as piperacillin and tazobactam to treat that condition. Results from these patients were compared with outcomes of 50 patients undergoing the same procedure at the hospital.
• Low levels of immune cells accompanied by fever occurred in 96% of patients who were hospitalized, compared with only 76% of patients treated at home.
• Duration of fever lasted approximately two days for patients treated at home, compared with six days for patients treated at the hospital.
• Hospital re-admission among patients treated at home was only required in 8% of cases, resulting 19 fewer days spent in the hospital.
• Medical costs were approximately half for patients treated at home compared to those treated at the hospital.
The researchers concluded that, when following specific guidelines, at-home autologous stem cell transplantation appears feasible among patients with hematologic malignancies. Patients who are to undergo an autologous stem cell transplant may wish to discuss their individual risks and benefits of at-home treatment with their physician.
Reference: Fernandez-Aviles F, Carreras E, Urbano-Ispizua A, et al. Case-Control Comparison of At-Home to Total Hospital Care for Autologous Stem-Cell Transplantation for Hematologic Malignancies. Journal of Clinical Oncology. 2006; 24: 4855-4861.