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A reproducible and safe at-home allogeneic haematopoietic cell transplant program: first experience in Central and Southern Europe

Bone Marrow Transplantation volume 55, pages 965–973 (2020)Cite this article

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Abstract

In 2015, we implemented an at-home allogeneic haematopoietic cell transplant (allo-HCT) program. Between 2015 and 2018, 252 patients underwent allo-HCT; 41 patients underwent allo-HCT in the at-home program (46% myeloablative; 63% unrelated donor; 32% posttransplant cyclophosphamide), and these patients were compared with 39 in-patients; safety, capacity to release beds for other programs, and economic efficiency cost were evaluated. We observed a lower incidence of febrile neutropenia in the at-home group compared with that in the in-patient group (32% versus 90%; p < 0.0001), whereas the incidence of aspergillosis was similar among groups (at-home 1% versus in-patient 3%; p = 0.5). The at-home patients showed a lower incidence of 1-year severe graft-versus-host disease (GVHD; 10% versus 29%; p = 0.03). There were no differences in 1-year transplant-related mortality, relapse, or overall survival among groups. The re-admission rate in the at-home group was 7%. The at-home setting was less expensive (9087 €/transplant), and its implementation increased capacity by 10.5 allo-HCTs/year. Moreover, a chimeric antigen receptor T-cell program could be established without increasing beds. Thus, our at-home allo-HCT program may be a safe modality to reduce febrile neutropenia and acute GVHD, resulting in lower re-admission rates.

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Fig. 1
Fig. 2
Fig. 3: Cumulative incidence of acute GVHD.
Fig. 4: Cumulative incidence of TRM and relapse.
Fig. 5: Series Outcome.

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Authors and Affiliations

  1. Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain

    Gonzalo Gutiérrez-García, Montserrat Rovira, Nacira Arab, Cristina Gallego, Joan Sánchez, María Ángeles Álvarez, Pilar Ayora, Ariadna Domenech, Nuria Borràs, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, Alexandra Pedraza, Alexandra Martínez-Roca, María Dolores Herrera, María Teresa Solano, Carla Ramos, Noemí de Llobet, Anna Serrahima, Carmen Martínez, María Suárez-Lledó, Álvaro Urbano-Ispizua & Francesc Fernández-Avilés

  2. University of Barcelona, Barcelona, Spain

    Gonzalo Gutiérrez-García, Montserrat Rovira, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, Alexandra Pedraza, Alexandra Martínez-Roca, Miquel Lozano, Joan Cid, Carmen Martínez, María Suárez-Lledó, Álvaro Urbano-Ispizua & Francesc Fernández-Avilés

  3. Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain

    Gonzalo Gutiérrez-García, Montserrat Rovira, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, Alexandra Pedraza, Alexandra Martínez-Roca, Miquel Lozano, Joan Cid, Carmen Martínez, María Suárez-Lledó, Álvaro Urbano-Ispizua & Francesc Fernández-Avilés

  4. Josep Carreras Leukemia Research Institute, Barcelona, Spain

    Gonzalo Gutiérrez-García, Montserrat Rovira, Luis Gerardo Rodríguez-Lobato, Laura Rosiñol, Pedro Marín, Alexandra Pedraza, Alexandra Martínez-Roca, Carmen Martínez, María Suárez-Lledó, Álvaro Urbano-Ispizua & Francesc Fernández-Avilés

  5. Department of Pharmacy, Hospital Clínic of Barcelona, Barcelona, Spain

    Esther Carcelero

  6. Department of Hemotherapy and Homeostasis, Hospital Clínic of Barcelona, Barcelona, Spain

    Miquel Lozano & Joan Cid

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  1. Gonzalo Gutiérrez-García
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Corresponding author

Correspondence to Gonzalo Gutiérrez-García.

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Conflict of interest

GGG received honoraria from Jazz Pharmaceuticals and MSD and grants from Pfizer, Jazz Pharmaceuticals, and Gilead. LR received honoraria from Janssen, Celgene, Amgen, and Takeda. The other authors have no conflicts of interest to declare.

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Gutiérrez-García, G., Rovira, M., Arab, N. et al. A reproducible and safe at-home allogeneic haematopoietic cell transplant program: first experience in Central and Southern Europe. Bone Marrow Transplant 55, 965–973 (2020). https://doi.org/10.1038/s41409-019-0768-x

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