Home-Care Program for Bone Marrow Patients

Researchers from the Institut Clínic of Haematology and Oncology of Hospital Clínic at the University of Barcelona (Barcelona, Spain) followed 178 patients who underwent ASCT for a hematologic malignancy--including such diseases as myeloma, lymphoma, and leukemia--between November 2000 and February 2005. A total of 50 patients were treated with an at-home ASCT program in which prophylactic ceftriaxone and treatment of febrile neutropenia with piperacillin and tazobactam were introduced to minimize the readmission rate. The results were compared with those from 50 other patients with similar characteristics who, despite their appropriateness for the home-care program, were hospitalized conventionally.

The results showed that febrile neutropenia occurred in fewer patients in the at-home group as compared with the hospitalized group, and duration of fever was also shorter in the at-home group. 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. Total median hospital charges were approximately half in the at-home group as compared with the in-hospital group. The results were published in the October 20, 2006, issue of the Journal of Clinical Oncology.

"This study has demonstrated that autologous bone marrow transplant can be done ambulatorily in a safe way and with important advantages for the patient. From our start in 2000, one out of three patients is treated at home, a mean of 12-15 patients per year,” said lead author Dr. Francesc Fernández-Avilés.

In order to receive home transplantation, patients needed to meet several requirements, the most important being voluntary participation in the program, having somebody to take care of them 24 hours a day, living relatively close to the hospital, and having the required hygienic conditions at home in order to avoid complications. Appropriate patients underwent preparatory treatment and bone-marrow infusion at the hospital and then returned home, where they were subsequently supervised by a group of nursing staff who monitored the patients daily for fever or other possible complications.



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