Post autologous hematopoietic cell transplant care in the “home sweet home” setting: a treatment paradigm shift

Abstract

Multiple myeloma (MM) is the second most common hematologic malignancy with 34,470 estimated new cases in 2022. High-dose therapy followed by autologous hematopoietic cell transplantation (auto-HCT) is a standard treatment for MM even in the era of novel therapies. This is usually done in hospital-based setting, whether in the inpatient or outpatient units. Advanced Care at Home (ACH) represents a virtual hybrid hospital-at-home program that combines a virtual provider-staffed command center with vendor-mediated supply chain capable of delivering high-acuity care in the comfort of patient’s own homes. In our program, we leveraged the existing ACH platform to deliver post-HCT care for recipients of auto-HCT. Four patients (female=2, 50%) with MM with a median age of 60 (range 40-74) years were admitted to the inpatient Blood and Marrow Transplant (BMT) unit. Conditioning regimen consisted of melphalan 200 mg/m2 administered on day -2. All received stem cell infusion (day 0) in the inpatient setting, with a median dose of 3.64 (range, 2.92-8.22) x 106/kg CD34 cells. Patients were discharged to their homes after completion of infusion on day 0 or day +1 at the latest. Post-infusion care was provided by the ACH team in coordination with the BMT team. Median time to ANC and platelets engraftment were 12 (range, 11-13) days and 11 (range, 9-16) days, respectively. All patients were successfully discharged from the ACH program at a median of day +14 (range, day +14 to day +15). Our results highlight the feasibility of delivering post-HCT care for auto-HCT recipients in the home setting and confirm the generalizability of this approach.

Recommended Citation

Kharfan-Dabaja, Mohamed A.; Roy, Vivek; Murthy, Hemant; Fischer, Deborah; Mohty, Razan; Greathouse, Ashley; Brown, Alethea; Moreno, Kathryn; Godsey, Emily; Higginbotham, Jennifer M.; Bartholomew, Ashley; Jackson, Alexis; Torres-Guzman, Ricardo A.; Forte, Antonio J.; Ailawadhi, Sikander; Dronca, Roxana; and Maniaci, Michael (2023) "Post autologous hematopoietic cell transplant care in the “home sweet home” setting: a treatment paradigm shift," Hematology/Oncology and Stem Cell Therapy: Vol. 16 : Iss. 4 , Article 16.
Available at: https://doi.org/10.56875/2589-0646.1088