Herrmann R P, Trent M, Cooney J, Cannell P K
Bone Marrow Transplant Unit, Royal Perth Hospital, Australia.
Bone Marrow Transplant. 1999 Dec;24(11):1213-7. doi: 10.1038/sj.bmt.1702044.
A group of 51 patients with multiple myeloma, non-Hodgkin's lymphoma or Hodgkin's disease receiving high-dose chemotherapy and autologous peripheral blood stem cell rescue received chemotherapy and clinical care in the peritransplant period at home. This group was compared with 88 cases with the same diagnoses, receiving the peripheral stem cell transplant over the same time period as an inpatient in a high efficiency particulate air filtered bone marrow transplant unit. Patients were treated at home based on choice, geographic accessibility, availability of an educated care giver and a clean home environment, and comprehension of the concepts of infection and aseptic techniques. Febrile neutropenia and sepsis were not increased in the home group and no episodes of septic shock were seen in this group. Patients at home received prophylactic oral ciprofloxacin and roxithromycin during the phase when the absolute neutrophil count was < 1 x 10(9)/l. Fewer gram-negative infections, but no diminution in gram-positive infections or in the rate of fever were seen in patients at home. Empiric therapy with a third generation cephalosporin, teicoplanin and tobramycin was instituted in 31 patients who developed a fever greater than 38.5 degrees C. Of this group of 31, 18 required admission to hospital, 12 because of febrile neutropenia which persisted or was considered unsuitable for management at home due to sepsis. The remaining 13 with febrile neutropenia remained at home throughout, as did the 20 cases not developing neutropenic fever. This study demonstrates the feasibility of managing carefully selected patients in their home environment when at risk from febrile neutropenia or other septic complications following autologous peripheral stem cell support.
一组51例患有多发性骨髓瘤、非霍奇金淋巴瘤或霍奇金病的患者接受了大剂量化疗及自体外周血干细胞救援，他们在移植前后在家中接受化疗及临床护理。该组与88例诊断相同的患者进行比较，这88例患者在同一时期于高效空气过滤骨髓移植病房住院接受外周干细胞移植。患者基于个人选择、地理位置便利性、有受过教育的护理人员以及清洁的家庭环境，并且理解感染和无菌技术的概念而选择在家接受治疗。在家治疗组的发热性中性粒细胞减少症和败血症并未增加，且该组未出现感染性休克病例。在家治疗的患者在绝对中性粒细胞计数<1×10⁹/L阶段接受预防性口服环丙沙星和罗红霉素治疗。在家治疗的患者革兰阴性菌感染较少，但革兰阳性菌感染及发热率并未降低。31例体温高于38.5℃的患者接受了第三代头孢菌素、替考拉宁和妥布霉素的经验性治疗。在这31例患者中，18例需要住院，其中12例是因为发热性中性粒细胞减少症持续存在或因败血症被认为不适于在家治疗。其余13例发热性中性粒细胞减少症患者全程在家治疗，20例未发生中性粒细胞减少性发热的患者也是如此。这项研究表明，对于经过精心挑选、在自体外周干细胞支持后有发热性中性粒细胞减少症或其他感染并发症风险的患者，在家庭环境中进行管理是可行的。
