Is it safe to treat allogeneic stem cell transplant recipients at home during the pancytopenic phase? - A pilot trial

After myeloablative treatment and allogeneic stem cell transplantation (ASC T), patients are kept isolated in the hospital to prevent infections during neutropenia, To date, 22 patients have been given the choice of being trea ted at home. Eleven could not be treated at home, and they served as contro ls. Most had haematological malignancies. The donors were 12 HLA-compatible unrelated, nine HLA-identical siblings and one twin. In the home care grou p, three developed bacteraemia, compared to nine in the controls (P < 0.01) , Patients in the home care group had fewer days of total parenteral nutrit ion (median 3 vs 24, P < 0.001), required fewer erythrocyte transfusions (m edian 4 vs 8, P = 0.01), fewer days on i.v, antibiotics (median 6 vs 13 day s), and on analgesics (median 0 vs 15) than the controls (P < 0.05), Days w ith fever, time to engraftment, days with G-CSF and acute GVHD were the sam e in the two groups. Seven of 11 patients treated at home were readmitted t o the ward for a median of 3 (0-7) days, due to fever or lack of a caregive r at home, Days to discharge to the out-patient clinic were faster in the g roup treated at home (median 20 vs 35 days, P < 0.01), Patients who were tr eated at home enjoyed being active and taking a walk when they felt like it . This preliminary report suggests that home care after ASCT is not only sa fe, but superior to isolation in the hospital.