Hospital Length of Stay in the First 100Days after Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia in Remission: Comparison among Alternative Graft Sources

Karen K. Ballen, Steven Joffe, Ruta Brazauskas, Zhiwei Wang, Mahmoud D. Aljurf, Görgün Akpek, Christopher Dandoy, Haydar A. Frangoul, César O. Freytes, Nandita Khera, Hillard M. Lazarus, Charles F. LeMaistre, Paulette Mehta, Susan K. Parsons, David Szwajcer, Celalettin Ustun, William A. Wood, Navneet S. Majhail

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Several studies have shown comparable survival outcomes with different graft sources, but the relative resource needs of hematopoietic cell transplantation (HCT) by graft source have not been well studied. We compared total hospital length of stay in the first 100days after HCT in 1577 patients with acute leukemia in remission who underwent HCT with an umbilical cord blood (UCB), matched unrelated donor (MUD), or mismatched unrelated donor (MMUD) graft between 2008 and 2011. To ensure a relatively homogenous study population, the analysis was limited to patients with acute myelogenous leukemia and acute lymphoblastic leukemia in first or second complete remission who underwent HCT in the United States. To account for early deaths, we compared the number of days alive and out of the hospital in the first 100days post-transplantation. For children who received myeloablative conditioning, the median time alive and out of the hospital in the first 100days was 50days for single UCB recipients, 54days for double UCB recipients, and 60days for MUD bone marrow (BM) recipients. In multivariate analysis, use of UCB was significantly associated with fewer days alive and out of the hospital compared with MUD BM. For adults who received myeloablative conditioning, the median time alive and out of the hospital in first 100days was 52days for single UCB recipients, 55days for double UCB recipients, 69days for MUD BM recipients, 75days for MUD peripheral blood stem cell (PBSC) recipients, 63days for MMUD BM recipients, and 67days for MMUD PBSC recipients. In multivariate analysis, UCB and MMUD BM recipients had fewer days alive and out of the hospital compared with recipients of other graft sources. For adults who received a reduced-intensity preparative regimen, the median time alive and out of the hospital during the first 100days was 65days for single UCB recipients, 63days for double UCB recipients, 79days for MUD PBSC recipients, and 79days for MMUD PBSC recipients. Similar to the other 2 groups, receipt of UCB was associated with a fewer days alive and out of the hospital. In conclusion, length of stay in the first 100days post-transplantation varies by graft source and is longer for UCB HCT recipients. These data provide insight into the resource needs of patients who undergo HCT with these various graft sources.

Original languageEnglish (US)
Pages (from-to)1819-1827
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number11
DOIs
StatePublished - Nov 1 2014

Bibliographical note

Funding Information:
Financial Disclosure: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute , the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases ; a Grant/Cooperative Agreement 5U01HL069294 from NHLBI and NCI ; a contract HHSH234200637015 C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research ; and grants from AABB ; Allos, Inc. ; Amgen, Inc. ; Anonymous donation to the Medical College of Wisconsin ; Astellas Pharma US, Inc. ; Be the Match Foundation ; Biogen Idec BioMarin Pharmaceutical, Inc. ; Biovitrum AB ; BloodCenter of Wisconsin ; Blue Cross and Blue Shield Association ; Bone Marrow Foundation ; The Bailey Family Foundation ; Terumo BCT Celgene ; CellGenix Children's Leukemia Research Association ; ClinImmune Labs ; CTI Clinical Trial and Consulting Services ; Eisai, Inc. ; Genentech, Inc. ; Genzyme Corporation ; Histogenetics, Inc. ; HKS Medical Information Systems ; Hospira, Inc. ; Kirin Brewery Co., Ltd. ; The Leukemia & Lymphoma Society ; Merck & Company ; The Medical College of Wisconsin ; Millennium Pharmaceuticals, Inc. ; Miller Pharmacal Group ; Milliman USA, Inc. ; Miltenyi Biotec, Inc. ; National Marrow Donor Program ; Nature Publishing Group ; Novartis Oncology ; Oncology Nursing Society ; Osiris Therapeutics, Inc. ; Otsuka America Pharmaceutical, Inc. ; Pall Life Sciences ; Pfizer Inc ; Schering Corporation ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; StemCyte, Inc. ; StemSoft Software, Inc. ; Sysmex America, Inc. ; Texas Instruments Inc. ; Vidacare Corporation ; ViraCor Laboratories ; ViroPharma, Inc. ; and WellPoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the; Navy, the Department of Defense, or any other agency of the U.S. Government.

Keywords

  • Hematopoietic cell transplantation
  • Length of stay
  • Leukemia
  • Resource utilization
  • Umbilical cord blood

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