Days Alive Outside Hospital and Readmissions in Patients Undergoing Allogeneic Transplants from Identical Siblings or
Federica Sora1,2, Patrizia Chiusolo1,2, Luca Laurenti1,2
1Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
Insights
Allogeneic stem cell transplants using alternative donors resulted in fewer days alive outside the hospital and higher readmission rates compared to sibling donors. Readmissions significantly increased mortality risk after HSCT.
Area of Science:
- Hematology
- Transplant Immunology
- Oncology
Background:
- Allogeneic hemopoietic stem cell transplant (HSCT) is a critical treatment for various hematologic malignancies and other diseases.
- Assessing patient outcomes, including time spent outside the hospital and readmission rates, is crucial for evaluating transplant success and healthcare resource utilization.
Purpose of the Study:
- To investigate the impact of donor type (sibling vs. alternative) on days alive outside the hospital (DAOH) and 100-day readmission rates following HSCT.
- To identify predictors of DAOH and readmission, and to evaluate the association between readmission and non-relapse mortality (NRM) and survival.
Main Methods:
- Retrospective analysis of 185 patients undergoing allogeneic HSCT.
- Comparison of outcomes between matched sibling (SIB) and alternative (ALT) donor groups.
- Statistical analysis to identify predictors of DAOH, readmission, NRM, and survival.
Main Results:
- Sibling (SIB) donor transplants showed significantly higher median DAOH (78 days) compared to alternative (ALT) donor transplants (73 days).
- Readmission within 100 days occurred in 22% of patients, predicted by acute graft-versus-host disease (GvHD), higher comorbidity index, and ALT donors.
- Readmitted patients had significantly higher NRM (25%) and poorer survival compared to non-readmitted patients.
Conclusions:
- Alternative donor HSCT is associated with shorter DAOH and higher readmission rates, potentially leading to increased hospital stays and costs.
- Acute GvHD, comorbidity index, and donor type are key predictors of readmission.
- Readmission within 100 days post-HSCT is a strong independent predictor of increased NRM and decreased survival.
Abstract:
We have studied the number of days alive outside the Hospital (DAOH) and the number of readmissions 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, range 21-84) was significantly greater than DAOH for ALT donor grafts (73 days, range 2-87) (p=0.0003). Other positive predictors of DAOH were the use of reduced-intensity regimens (p=0.01), grade 0-I acute graft versus host disease (GvHD) (p=0.0006), and a comorbidity index equal or less than two (p=0.04). Fifty-one patients required readmission (22%), which was predicted by grade II-IV acute GvHD (p=0.009), higher comorbidity index (p=0.06), and ALT donors as compared to SIBS (p=0.08). The CI of readmission was 18% (95%CI 10-31) for SIB and 30% (95%CI 23-39) for ALT donor grafts. The non relapse mortality (NRM) for patients re-admitted was 25% (95%CI 15-43%), compared to 5% (95%CI 2-12%) for patients not readmitted (p=0.0001). In a multivariate analysis, readmission was the strongest predictor of non-relapse mortality (NRM) (HR 2.0) (p=0.0006) and survival (HR 3.4) (p<0.0001).
In Conclusion:
ALT donor transplants have lower numbers of DAOH, as compared to SIB grafts, which implies longer stay in hospital and higher costs. Readmission to hospital within 100 days, is predicted by acute GvHD, comorbidity index, donor type, and has a significant strong impact on non-relapse mortality and survival.
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