Translational Cell Therapy Research, Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
BIH Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany.
Front Immunol. 2024 Aug 7;15:1384137. doi: 10.3389/fimmu.2024.1384137. eCollection 2024.
After allogeneic hematopoietic cell transplantation (Allo-HCT) and conditioning, patients are typically placed in isolated hospital rooms to prevent neutropenic infections. Since 1998, we've offered an alternative: home care for patients living within a one to two-hour drive of the hospital. In Sweden this approach includes daily visits by an experienced nurse and daily phone consultations with a unit physician. When necessary, patients receive transfusions, intravenous antibiotics, and total parenteral nutrition at home. Our initial study report compared 36 home care patients with 54 hospital-treated controls. Multivariate analysis found that home care patients were discharged earlier to outpatient clinics, required fewer days of total parenteral nutrition, had less acute graft-versus-host disease (GVHD) grade II-IV, and lower transplantation-related mortality (TRM) and lower costs. Long-term follow-up showed similar chronic GVHD and relapse rates in both groups, with improved survival rates in the home care group. A subsequent comparison of 146 home care patients with hospital-treated controls indicated that home care and longer home stays were associated with lower grades of acute GVHD. Home care was found to be safe and beneficial for children and adolescents. Over two decades, 252 patients received home care post-Allo-HCT without any fatalities at-home. Ten-year outcomes showed a 14% TRM and a 59% survival rate. In 2020, an independent center confirmed the reduced risk of acute GVHD grades II-IV for patients treated in home care. Here, we report for the first time that home care patients also demonstrate a less inflammatory systemic cytokine profile. We found higher levels of IFN-γ, IL-2, IL-5, IL-13, GM-CSF, and G-CSF, but lower VEGF in hospital-treated patients, which may contribute to acute GVHD grades II-IV. In conclusion, home-based treatment following Allo-HCT yields multiple promising clinical outcomes and improved systemic inflammatory markers, which may contribute to less development of life-threatening GVHD.
异基因造血细胞移植（Allo-HCT）和预处理后，患者通常被安置在隔离的病房中，以预防中性粒细胞减少性感染。自 1998 年以来，我们提供了一种替代方案：为居住在距医院一小时或两小时车程内的患者提供家庭护理。在瑞典，这种方法包括由经验丰富的护士每天上门访问和与单位医生每天进行电话咨询。必要时，患者可在家中接受输血、静脉内抗生素和全胃肠外营养。我们的初步研究报告比较了 36 名家庭护理患者和 54 名住院治疗对照组。多变量分析发现，家庭护理患者更早出院到门诊，需要的全胃肠外营养天数更少，急性移植物抗宿主病（GVHD）Ⅱ-Ⅳ级发生率更低，移植相关死亡率（TRM）和成本更低。长期随访显示两组慢性 GVHD 和复发率相似，但家庭护理组的生存率提高。随后对 146 名家庭护理患者和住院治疗对照组进行比较，表明家庭护理和更长的家庭停留时间与较低的急性 GVHD 分级相关。家庭护理被发现对儿童和青少年是安全且有益的。二十多年来，252 名患者在接受 Allo-HCT 后接受家庭护理，没有任何在家中死亡的情况。十年的结果显示 TRM 为 14%，生存率为 59%。2020 年，一个独立的中心证实了家庭护理患者急性 GVHD Ⅱ-Ⅳ级的风险降低。在这里，我们首次报告家庭护理患者还表现出较低的全身炎症细胞因子谱。我们发现，住院治疗患者的 IFN-γ、IL-2、IL-5、IL-13、GM-CSF 和 G-CSF 水平较高，而 VEGF 水平较低，这可能导致急性 GVHD Ⅱ-Ⅳ 级。总之，Allo-HCT 后基于家庭的治疗可带来多种有前景的临床结果和改善的全身炎症标志物，这可能有助于减少危及生命的 GVHD 的发生。
