Division of Hematology, The Ohio State University, Columbus, Ohio.
Division of Hematology, The Ohio State University, Columbus, Ohio.
Transplant Cell Ther. 2021 Apr;27(4):337.e1-337.e7. doi: 10.1016/j.jtct.2020.11.015. Epub 2020 Dec 17.
Many hematopoietic cell transplantation (HCT) recipients require rehabilitation due to deconditioning following intensive conditioning regimens and immune reconstitution. HCT recipients are preferentially discharged to home to avoid the risk of exposure to healthcare-associated infection in a rehabilitation facility (RF), with a caregiver who has been provided specific education about the complexity of post-HCT care. This study was conducted to determine the incidence of discharge to an RF following HCT, identify pre-HCT and peri-HCT risk factors for discharge to an RF, and estimate the effect of discharge disposition on overall survival (OS). This retrospective, matched 1:4 case-control study included 56 cases over a 10-year period from a single institution. Controls were matched by transplantation type (autologous versus allogeneic) and date of transplantation. The incidence of discharge to an RF was 2.2%. Controlling for disease, increasing age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04 to 1.15; P < .001), female sex (OR, 3.11; 95% CI, 1.32 to 7.32; P = .01), high-risk HCT Comorbidity Index (HCT-CI) score (≥3) (OR, 3.44; 95% CI, 1.39 to 8.52; P = .008), decreasing pre-HCT serum albumin (OR, 2.60; 95% CI, 1.07 to 6.38; P = .037), and development of acute kidney injury during HCT (OR, 4.10; 95% CI, 1.36 to 12.40; P = .012) were associated with discharge to an RF. Discharge to an RF was associated with worse OS and higher nonrelapse mortality (NRM) compared with discharge to home (1-year OS, 70.5% [95% CI, 55.8% to 81.1%] versus 88.8% [95% CI, 83.6% to 92.4%], P < .001; 100-day NRM: 9.5% [95% CI, 3.5% to 19.2%] versus 1.8% [95% CI, 0.6% to 4.3%]; P = .03). Discharge to an RF following HCT is a rare event but associated with poor OS. Modifiable risk factors for discharge to an RF, including serum albumin as a measure of nutrition and reversible HCT-CI components, should be prospectively studied to determine the effect of mitigation on discharge disposition and survival.
许多接受造血细胞移植 (HCT) 的患者由于强化调理方案和免疫重建后身体状况不佳，需要康复。为了避免在康复机构 (RF) 中接触医疗相关感染的风险，HCT 受者优先出院回家，由经过特定教育的护理人员照顾，以了解 HCT 后的护理复杂性。本研究旨在确定 HCT 后出院到 RF 的发生率，确定 HCT 前和 HCT 期间出院到 RF 的风险因素，并估计出院处理方式对总生存率 (OS) 的影响。这项回顾性、1:4 病例对照研究包括了来自一家机构的 10 年内的 56 例病例。对照病例通过移植类型（自体与同种异体）和移植日期进行匹配。HCT 后出院到 RF 的发生率为 2.2%。控制疾病后，年龄增长（比值比 [OR]，1.09；95%置信区间 [CI]，1.04 至 1.15；P<.001）、女性（OR，3.11；95%CI，1.32 至 7.32；P=.01）、高危 HCT 合并症指数 (HCT-CI) 评分（≥3）（OR，3.44；95%CI，1.39 至 8.52；P=.008）、HCT 前血清白蛋白降低（OR，2.60；95%CI，1.07 至 6.38；P=.037）和 HCT 期间发生急性肾损伤（OR，4.10；95%CI，1.36 至 12.40；P=.012）与出院到 RF 有关。与出院回家相比，出院到 RF 与较差的 OS 和更高的非复发死亡率 (NRM) 相关（1 年 OS，70.5%[95%CI，55.8%至 81.1%]与 88.8%[95%CI，83.6%至 92.4%]，P<.001；100 天 NRM：9.5%[95%CI，3.5%至 19.2%]与 1.8%[95%CI，0.6%至 4.3%]；P=.03）。HCT 后出院到 RF 是一种罕见事件，但与较差的 OS 相关。应前瞻性研究出院到 RF 的可改变风险因素，包括血清白蛋白作为营养的衡量标准和可逆转的 HCT-CI 成分，以确定缓解措施对出院处理方式和生存率的影响。
