At home management of aplastic phase following high-dose chemotherapy withstem-cell rescue for hematological and non-hematological malignancies

Background: After high-dose chemotherapy with autologous stem-cell support long hospital stays in the aplastic phase are expensive, lead to increased risk of hospital infections and to increasing pressure on available hospita l beds. We developed a home care regimen that allows patients to be at home for most of the aplastic period, without daily hospital visits. Patients and methods: Between October 1995 and December 1997, transfer of s upportive care to the home setting took place in three phases for patients undergoing high-dose chemotherapy with stem-cell transplant for malignant l ymphoma (one course of BEAM), breast cancer or germ-cell cancer (three cour ses of tCTC). In the inpatient cohort, the supportive care designed for at home use was administered in the hospital until neutrophile recovery to 0.5 x 10(9)/l. In the second, outpatient cohort, patients were discharged the day after stem-cell reinfusion but the supportive care was delivered daily in hospital. The third, home care cohort, consisted of patients who were di scharged the day after stemcell reinfusion, after which specialized home ca re professionals delivered all supportive care including transfusions and p arenteral antibiotics at home, with once weekly check-up in hospital by the transplant physician. Results: Forty-two patients were treated with 81 cycles of high-dose chemot herapy (11, 18 and 13 patients and 17, 40 and 24 courses in the inpatient, outpatient and home care cohorts respectively). Inpatients were hospitalize d in the aplastic phase for a median of 14 days. Patients in the outpatient cohort were at home in the aplastic phase for a median of six days (with a median of six days in hospital), and in the home care cohort for a median of 10 days (with a median of 1.5 days in hospital). Unscheduled readmission s and hospital visits were frequent in the outpatient and home care cohorts , mostly due to fever, central indwelling catheter malfunctioning or chemot herapy-related toxicity. However, patients could usually be discharged agai n after observation and treatment. No infectious deaths or unexpected emerg encies occurred in the outpatient or home care cohort. Neither was there an y suggestion of an increased number of fevers, infections, or other complic ations. Conclusions: At home management in the aplastic phase after high-dose chemo therapy and stemcell transplant by community-based professionals is feasibl e without signs of increased toxicity or infections.