Case-control comparison of at-home and hospital care for allogeneic hematopoietic stem-cell transplantation: the role of oral nutrition

Transplantation. 2008 Apr 15;85(7):1000-7. doi: 10.1097/TP.0b013e31816a3267.


Background: Acute graft-versus-host disease (GVHD) was reduced using home care compared with hospital care after allogeneic hematopoietic stem-cell transplantation (ASCT).

Methods: Between March 1998 and December 2006, 601 patients underwent ASCT at our unit. Requirements for at-home ASCT were fulfilled by 76 patients. A control group of 76 patients treated in the hospital were matched for age, sex, diagnosis, stage of disease, conditioning, stem-cell source, type of donor, and immunosuppression. Oral nutrition was determined as median kcal/kg/day for the first 21 days after ASCT.

Results: The home-care patients received more oral nutrition per day than hospital controls (P<0.05). Number of days at home correlated with oral nutrition (P=0.004). In multivariate analysis, acute GVHD of grades II to IV was associated with poor oral nutrition (P=0.003) and hospital care (P=0.06). Transplant-related mortality was associated with acute GVHD grades II to IV (P<0.0001) and bacteremia (P=0.004). In addition to acute GVHD and bacteremia, death was associated with absence of chronic GVHD (P=0.012). Five-year survival was 65% in patients treated at home, when compared with 47% in the controls (P=0.04).

Conclusion: Better oral nutrition may be one reason for the reduced probability of acute GVHD and better survival with at-home care than with hospital care.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Case-Control Studies*
  • Child
  • Community Health Nursing
  • Energy Intake
  • Female
  • Graft vs Host Disease / epidemiology
  • Hematopoietic Stem Cell Transplantation / methods*
  • Hematopoietic Stem Cell Transplantation / mortality
  • Home Care Services*
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / surgery
  • Nutrition Assessment*
  • Parenteral Nutrition, Total / mortality
  • Transplantation, Homologous / physiology*