DAYS ALIVE OUTSIDE HOSPITAL AND RE-ADMISSIONS IN PATIENTS UNDERGOING ALLOGENEIC TRANSPLANTS FROM IDENTICAL SIBLINGS, UNRELATED DONORS OR HAPLOIDENTICAL DONORS “.

Abstract

We have studied the number of days alive outside Hospital (DAOH) and the number of re-admissions within the first 100 days after transplant in 185 patients who received an allogeneic hemopoietic stem cell transplant (HSCT). The donors were matched siblings (SIB; n=61), or alternative donors (ALT; n=124). The median number of DAOH for SIB transplants (78 days) was significantly greater than DAOH for ALT donor grafts (73 days) (p=0.0003) . Other positive predictors of DAOH were the use of reduced intensity regimens (p=0.01), grade 0-I graft versus host disease (GvHD) (p=0.0006) and a comorbidity index equal or less than two (p=0.04). Fifty one patients required re-admission (22%), which was predicted by grade II-IV GvHD (p=0.009), higher comorbidity index (p=0.06) and ALT donors as compared to SIBS (p=0.08). The CI of re-admission was 18% for SIB and 30% for ALT donor grafts. The non relapse mortality (NRM) for patients re-admitted was 25%, compared to 5% for patients not readmitted (p=0.0001). In a multivariate analysis re-admission was the strongest predictor of non relapse mortality (NRM) (p=0.0006) and survival (p<0.0001). In conclusions: ALT donor transplants have lower numbers of DAOH, as compared to SIB grafts, which implies longer stay in hospital and greater cost. Re-admission to Hospital within 100 days, is predicted by GvHD, comorbidity index, donor type, and has a very strong impact on non relapse mortality and survival.

Keywords

• Allogeneic haemopietic stem stell transplantation , re-admission, length of stay, healthcare and personalized medical care