Work

Burden of Hospitalization in Allogeneic Stem-Cell Transplantation for Acute Myeloid Leukemia

Year: 2019

Type: article

Abstract: Background Allogeneic stem cell transplantation (allo-SCT) is an effective, potentially curative treatment for acute myeloid leukemia (AML) patients. Inpatient stay accounts for the majority of healthcare resource use (HCRU) associated with the procedure. Furthermore, after being discharged, patients are at risk of readmission due to transplant-related events. Objective The study aimed to systematically review the length of hospital stay (LoS) associated with allo-SCT in AML patients, with a focus on relapsed or refractory AML (R/R AML). Evidence Acquisition A systematic review was conducted in PubMed, Embase, Cochrane and grey literature. Studies reporting LoS in AML patients associated with the pre-transplant therapy, transplantation and transplant-related events were included. Results Ten studies were included. The studies distinguished between three phases of pre-transplant therapy: induction (phase 1), consolidation (phase 2), conditioning (phase 3), followed by transplantation and post-transplant complications. The mean LoS from the start of induction therapy to readmission for those who develop transplant-related complications ranged from 56 to 104 days. For the induction therapy (phase 1), the mean LoS ranged from 22 to 68 days. Longer duration corresponded to two consecutive induction courses. The reported mean LoS of consolidation therapy (phase 2) ranged from 27 to 32 days. The third phase of pre-transplant treatment – conditioning - required from 6 to 8 inpatient days. The reported mean LoS for transplantation ranged from 23 to 28 days. The mean duration of readmission due to transplant complications ranged from 8 to 34 days. The data on the causes of readmission was not collected due to the insufficient information specific for AML population. In relapsed AML patients, the reported mean LoS for reinduction ranged from 32 to 45 days, depending on the treatment utilized. Conclusion LoS related to pre-transplant therapy and post-transplant complications pose a substantial burden on AML patients undergoing allo-SCT. R/R AML patients have low response rates to salvage therapies. Further studies in LoS, focusing specifically on R/R AML patients, would contribute to the evidence on the burden of hospitalization in AML. Novel, targeted conditioning and anti-leukemia therapies with a potential to shorten the duration of inpatient stay and reduce the risk of readmission are needed to reduce the burden of hospitalization.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2018.12.376