TY - JOUR
T1 - Post-Autologous Hematopoietic Cell Transplant Care in the “Home Sweet Home” Setting
T2 - A Treatment Paradigm Shift
AU - Kharfan-Dabaja, Mohamed A.
AU - Roy, Vivek
AU - Murthy, Hemant
AU - Fischer, Deborah
AU - Mohty, Razan
AU - Greathouse, Ashley
AU - Brown, Alethea
AU - Moreno, Kathryn
AU - Godsey, Emily
AU - Higginbotham, Jennifer M.
AU - Bartholomew, Ashley
AU - Jackson, Alexis
AU - Torres-Guzman, Ricardo A.
AU - Forte, Antonio J.
AU - Ailawadhi, Sikander
AU - Dronca, Roxana
AU - Maniaci, Michael
N1 - Publisher Copyright:
© 2023 King Faisal Specialist Hospital and Research Centre. All rights reserved.
PY - 2023
Y1 - 2023
N2 - Background: Multiple myeloma (MM) is the second most common hematologic malignancy, with 34,470 estimated new cases in 2022. High-dose therapy followed by autologous hematopoietic cell transplantation (auto-HCT) remains a standard treatment for MM even in the era of novel therapies. This is usually performed in hospital-based settings, either in the inpatient or outpatient units. Advanced Care at Home (ACH) represents a virtual hybrid hospital-at-home program that combines a virtual provider-staffed command center with a vendor-mediated supply chain capable of delivering high-acuity care in the comfort of the patients’ own homes. In our program, we used the existing ACH platform to deliver post-HCT care for recipients of auto-HCT. Patients and methods: Four patients (female ¼ 2, 50%) with MM, with a median age of 60 (range, 40e74) years, were admitted to the inpatient Blood and Marrow Transplant (BMT) unit. The conditioning regimen consisted of melphalan 200 mg/m2, administered on day ¡2. All patients received stem cell infusion (day 0) in the inpatient setting, with a median dose of 3.64 (range, 2.92e8.22) £ 106/kg CD34 cells. Results: Patients were discharged to their homes after completing the infusion on day 0 or day þ1 at the latest. Post-infusion care was provided by the ACH team in coordination with the BMT team. The median time intervals to absolute neutrophil count and platelet engraftment were 12 (range, 11e13) and 11 (range, 9e16) days, respectively. All patients were successfully discharged from the ACH program at a median of day þ14 (range, day þ14 to day þ15). Conclusions: Our results highlight the feasibility of delivering post-HCT care for auto-HCT recipients in the home setting and confirm the generalizability of this approach.
AB - Background: Multiple myeloma (MM) is the second most common hematologic malignancy, with 34,470 estimated new cases in 2022. High-dose therapy followed by autologous hematopoietic cell transplantation (auto-HCT) remains a standard treatment for MM even in the era of novel therapies. This is usually performed in hospital-based settings, either in the inpatient or outpatient units. Advanced Care at Home (ACH) represents a virtual hybrid hospital-at-home program that combines a virtual provider-staffed command center with a vendor-mediated supply chain capable of delivering high-acuity care in the comfort of the patients’ own homes. In our program, we used the existing ACH platform to deliver post-HCT care for recipients of auto-HCT. Patients and methods: Four patients (female ¼ 2, 50%) with MM, with a median age of 60 (range, 40e74) years, were admitted to the inpatient Blood and Marrow Transplant (BMT) unit. The conditioning regimen consisted of melphalan 200 mg/m2, administered on day ¡2. All patients received stem cell infusion (day 0) in the inpatient setting, with a median dose of 3.64 (range, 2.92e8.22) £ 106/kg CD34 cells. Results: Patients were discharged to their homes after completing the infusion on day 0 or day þ1 at the latest. Post-infusion care was provided by the ACH team in coordination with the BMT team. The median time intervals to absolute neutrophil count and platelet engraftment were 12 (range, 11e13) and 11 (range, 9e16) days, respectively. All patients were successfully discharged from the ACH program at a median of day þ14 (range, day þ14 to day þ15). Conclusions: Our results highlight the feasibility of delivering post-HCT care for auto-HCT recipients in the home setting and confirm the generalizability of this approach.
KW - Advanced care at home
KW - Autologous hematopoietic stem cell transplantation
KW - Healthcare cost
KW - Multiple myeloma
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UR - http://www.scopus.com/inward/citedby.url?scp=85163299676&partnerID=8YFLogxK
U2 - 10.56875/2589-0646.1088
DO - 10.56875/2589-0646.1088
M3 - Article
C2 - 37363981
AN - SCOPUS:85163299676
SN - 1658-3876
VL - 16
SP - 407
EP - 411
JO - Hematology/ Oncology and Stem Cell Therapy
JF - Hematology/ Oncology and Stem Cell Therapy
IS - 4
ER -