Home-Based Hematopoietic Cell Transplantation in the United States.
Home-Based Hematopoietic Cell Transplantation in the United States.
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DOI：
10.1016/j.jtct.2022.01.015
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发表时间：
2022-04
影响因子：
3.2
通讯作者：
Chao NJ
中科院分区：
文献类型：
--
作者：
Sung AD;Giri VK;Tang H;Nichols KR;Lew MV;Bohannon L;Ren Y;Jung SH;Dalton T;Bush A;Van Opstal J;Artica A;Messina J;Shelby R;Frith J;Lassiter M;Burleson J;Leonard K;Potter AS;Choi T;Gasparetto CJ;Horwitz ME;Long GD;Lopez RD;Sarantopoulos S;Chao NJ
接受同种异体（allo）和自体（auto）造血细胞移植（HCT）的患者在移植期间需要大量住院或每日门诊。家庭HCT，其中患者住在家里，并且提供者每天前往患者的住所进行评估并提供任何必要的干预，可以提高患者的生活质量并改善结果。我们在美国进行了第一项家庭HCT研究，以评估该模型在美国医疗保健环境中的作用，并确定其对临床结局和生活质量的影响。这项病例对照研究评价了2012年11月至2018年3月在达勒姆的杜克大学接受家庭HCT的患者。每个家庭HCT患者与来自同一机构的两个对照组相匹配，这些对照组接受了基于年龄，疾病和移植类型的标准治疗以进行结果比较。从电子健康记录中提取临床结果，并通过FACT-BMT评估生活质量。临床结果采用Student t检验或Fisher精确检验（连续变量）或卡方检验（分类变量）进行比较。使用学生t检验比较生活质量评分。所有分析均使用0.05的显著性阈值。25例患者接受了家庭HCT，其中8例为同种异体，17例为自体。家庭HCT患者与其匹配对照之间的临床结局无显著差异;家庭HCT患者在移植后一年内复发率降低（表1）。自体家庭HCT患者的HCT前生活质量保持良好。这项I期研究表明，家庭HCT可以在美国成功实施。没有证据表明家庭HCT结局劣于标准治疗，接受自体家庭HCT的患者能够维持其生活质量。目前正在进行一项家庭与标准HCT的II期随机试验，以更好地比较结果和成本。
Patients undergoing allogeneic (allo) and autologous (auto) hematopoietic cell transplantation (HCT) require extensive hospitalizations or daily clinic visits for the duration of their transplant. Home HCT, wherein patients live at home and providers make daily trips to the patient’s residence to perform assessments and deliver any necessary interventions, may enhance patient quality of life and improve outcomes. We conducted the first study of home HCT in the United States to evaluate this model in the US healthcare setting and to determine the effect on clinical outcomes and quality of life. This case-control study evaluated patients who received home HCT at Duke University in Durham, NC from November 2012 to March 2018. Each home HCT patient was matched with two controls from the same institution who had received standard treatment based on age, disease, and type of transplant for outcomes comparison. Clinical outcomes were abstracted from electronic health records and quality of life was assessed via FACT-BMT. Clinical outcomes were compared with student’s t-test or Fisher’s exact test (continuous variables) or chi-square test (categorical variables). Quality of life scores were compared using the student’s t-test. All analyses used a significance threshold of 0.05. 25 patients received home HCT, including 8 allos and 17 autos. Clinical outcomes were not significantly different between the home HCT patients and their matched controls; home HCT patients had decreased incidence of relapse within one year of transplant (Table 1). Pre-HCT quality of life was well-preserved for autologous home HCT patients. This Phase I study demonstrated that home HCT can be successfully implemented in the United States. There was no evidence that home HCT outcomes were inferior to standard-of-care treatment, and patients undergoing autologous home HCT were able to maintain their quality of life. A Phase II randomized trial of home vs. standard HCT is currently underway to better compare outcomes and costs.
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影响因子：
3.1
作者：
Kopp, M;Schweigkofler, H;Sperner-Unterwerger, B
通讯作者：
Sperner-Unterwerger, B
影响因子：
4.8
作者：
Ghazikhanian, S. E.;Dorfman, C. S.;Shelby, R. A.
通讯作者：
Shelby, R. A.
影响因子：
9.7
作者：
Pallin, Daniel J.;Allen, Matthew B.;Bohan, J. Stephen
通讯作者：
Bohan, J. Stephen
影响因子：
2.6
作者：
Puig, Noemi;De La Rubia, Javier;Sanz, Miguel A.
通讯作者：
Sanz, Miguel A.
影响因子：
4.3
作者：
Dandoy, Christopher E.;Haslam, David;Davies, Stella M.
通讯作者：
Davies, Stella M.