Svahn Britt-Marie, Remberger Mats, Heijbel Mona, Martell Eva, Wikström Marie, Eriksson Britta, Milovsavljevic Ruza, Mattsson Jonas, Ringdén Olle
Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Transplantation. 2008 Apr 15;85(7):1000-7. doi: 10.1097/TP.0b013e31816a3267.
Acute graft-versus-host disease (GVHD) was reduced using home care compared with hospital care after allogeneic hematopoietic stem-cell transplantation (ASCT).
Between March 1998 and December 2006, 601 patients underwent ASCT at our unit. Requirements for at-home ASCT were fulfilled by 76 patients. A control group of 76 patients treated in the hospital were matched for age, sex, diagnosis, stage of disease, conditioning, stem-cell source, type of donor, and immunosuppression. Oral nutrition was determined as median kcal/kg/day for the first 21 days after ASCT.
The home-care patients received more oral nutrition per day than hospital controls (P<0.05). Number of days at home correlated with oral nutrition (P=0.004). In multivariate analysis, acute GVHD of grades II to IV was associated with poor oral nutrition (P=0.003) and hospital care (P=0.06). Transplant-related mortality was associated with acute GVHD grades II to IV (P<0.0001) and bacteremia (P=0.004). In addition to acute GVHD and bacteremia, death was associated with absence of chronic GVHD (P=0.012). Five-year survival was 65% in patients treated at home, when compared with 47% in the controls (P=0.04).
Better oral nutrition may be one reason for the reduced probability of acute GVHD and better survival with at-home care than with hospital care.
与异基因造血干细胞移植（ASCT）后的住院治疗相比，家庭护理可降低急性移植物抗宿主病（GVHD）的发生率。
1998年3月至2006年12月期间，601例患者在本单位接受了ASCT。76例患者满足家庭ASCT的要求。将76例在医院接受治疗的患者作为对照组，根据年龄、性别、诊断、疾病分期、预处理、干细胞来源、供体类型和免疫抑制情况进行匹配。口服营养以ASCT后前21天的中位数千卡/千克/天来确定。
家庭护理患者每天接受的口服营养比医院对照组更多（P<0.05）。在家天数与口服营养相关（P=0.004）。在多变量分析中，II至IV级急性GVHD与口服营养差（P=0.003）和住院治疗（P=0.06）相关。移植相关死亡率与II至IV级急性GVHD（P<0.0001）和菌血症（P=0.004）相关。除急性GVHD和菌血症外，死亡还与无慢性GVHD相关（P=
