Work

Remote Continuous Monitoring during Homebound Autologous Hematopoietic Cell Transplantation Is Feasible and May Supplant the Need for a Fulltime Caregiver

Year: 2025

Type: article

Abstract: Introduction Autologous hematopoietic cell transplantation (autoHCT) is standard consolidation for eligible patients (pts) with multiple myeloma (MM) but requires significant investment by pts and caregivers (CG) and represents a barrier to access. AutoHCT occurs in inpatient or outpatient settings and mandates a 24hr CG upon release from the hospital or for the duration of autoHCT, respectively. Performing autoHCT in a homebound setting where nurses deliver care to pts at home was studied to reduce CG burden and was found to be safe and feasible (Landau et al., 2022). Pt and CG satisfaction with the program was high despite an ongoing requirement for a full-time CG. We designed a trial to test the hypothesis that continuous remote monitoring can replace the need for a full-time CG. Here, we report the first 10 MM pts transplanted on our homebound protocol who underwent continuous heart rate (HR) monitoring starting day+1 after autoHCT. Methods This prospective, investigator-initiated trial included a 10 pt safety run-in with continuous HR monitoring from 8am-6pm using a Fitbit, but a 24hr CG was required. Blood pressure, temperature, and oxygen saturation were transmitted to the care team twice daily and the weight once daily. After 10 pts, if the technology proves reliable, 20 more pts will enroll without a full-time CG. Study details and schema are in Figure 1 . Results Ten pts (median age 57; 60% male) with MM received care at home starting day +1 following autoHCT. Pts remained in the program for an average of 10 days and required a median of 2 (range 1-2) outpatient visits, exclusively for transfusions, while receiving home care. Pts received a median of 3.5 (range 1-10) platelet and 0 (range 0 -5) RBC transfusions (pre/post-engraftment). Within the first 21 days post-autoHCT, 3/10 pts required hospitalization for a median of 7 days (range, 6 - 7). Admission occurred for neutropenic fever on day+8 in 2 pts and on day+10 in 1 pt, as well as concurrent mucositis (N=1) and engraftment syndrome (N=1). Documented infection (Streptococcus mitis) occurred for 1 pt, who was also readmitted with ES on day +15. There were no ICU admissions. Continuous HR data were reliably transmitted in real-time for all pts. Conclusions Homebound autoHCT can be done safely with only 30% of pts requiring hospitalization. Remote continuous HR monitoring is feasible. These results support proceeding with the next phase of the study where pts will be monitored remotely without the requirement of a full-time CG. The trial continues to accrue, and updated data will be presented at the meeting.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.01.535