Fernández-Avilés Francesc, Carreras Enric, Urbano-Ispizua Alvaro, Rovira Montserrat, Martínez Carmen, Gaya Anna, Granell Miquel, Ramiro Laia, Gallego Cristina, Hernando Adela, Segura Susana, García Lourdes, González Manel, Valverde Montserrat, Montserrat Emili
Department of Hematology, Institute of Hematology and Oncology, IDIBAPS, Postgraduate School of Hematology Farreras Valentí, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
J Clin Oncol. 2006 Oct 20;24(30):4855-61. doi: 10.1200/JCO.2006.06.4238. Epub 2006 Sep 25.
One of the most significant limitations of at-home autologous stem-cell transplantation (ASCT) is the necessity for hospital readmission. We developed an at-home ASCT program in which prophylactic ceftriaxone and treatment of febrile neutropenia with piperacillin and tazobactam was introduced to minimize the readmission rate.
Between November 2000 and February 2005, 178 consecutive patients underwent ASCT for a hematologic malignancy. Of these, 50 patients fulfilled the requirements for at-home ASCT. Results were compared with those observed in a control group of 50 patients individually matched to the group of patients treated at home for age, sex, diagnosis, stage of disease, conditioning, and source of stem cells.
Febrile neutropenia occurred in fewer patients in the at-home group as compared with the hospitalized group (76% v 96%: P = .008), and duration of fever was also shorter in the at-home group (median, 2 and 6 days, respectively; range, 1 to 11 and 1 to 20 days, respectively; P = .00003). Hospital readmission in the at-home group was required in only four cases (8%). This resulted in a reduction of 18.6 days of hospitalization per patient. Likewise, total median charges were approximately half in the at-home group as compared with the in-hospital group (3,345 euro v 6,250 euro, respectively; P < .00001).
Results of at-home ASCT with prophylactic administration of ceftriaxone and domiciliary treatment of febrile neutropenia with piperacillin and tazobactam are highly satisfactory and significantly cheaper compared with those obtained with conventional in-hospital ASCT.
家庭自体干细胞移植（ASCT）最显著的局限性之一是需要再次入院。我们开展了一项家庭ASCT项目，引入了预防性使用头孢曲松以及用哌拉西林和他唑巴坦治疗发热性中性粒细胞减少症的方法，以尽量降低再次入院率。
2000年11月至2005年2月期间，178例连续的患者因血液系统恶性肿瘤接受了ASCT。其中，50例患者符合家庭ASCT的要求。将结果与50例对照组患者进行比较，对照组患者在年龄、性别、诊断、疾病分期、预处理方案和干细胞来源方面与在家治疗的患者组进行个体匹配。
与住院组相比，家庭组发热性中性粒细胞减少症患者较少（76%对96%：P = 0.008），家庭组发热持续时间也较短（中位数分别为2天和6天；范围分别为1至11天和1至20天；P = 0.00003）。家庭组仅4例（8%）需要再次入院。这使得每位患者的住院天数减少了18.6天。同样，家庭组的总中位数费用约为住院组的一半（分别为3345欧元对6250欧元；P < 0.00001）。
与传统的住院ASCT相比，家庭ASCT预防性使用头孢曲松以及在家用哌拉西林和他唑巴坦治疗发热性中性粒细胞减少症的结果非常令人满意，且成本显著降低。
