1.
Factors Associated With Unplanned 30-Day Readmissions After Hematopoietic Cell Transplantation Among US Hospitals
Dhakal, B., Giri, S., Levin, A., Rein, L., Fenske, T. S., Chhabra, S., Shah, N. N., Szabo, A., D'Souza, A., Pasquini, M., et al
JAMA network open. 2019;2(7):e196476
Abstract
Importance: Hematopoietic cell transplantation (HCT) is a therapeutic strategy in the management of several hematological cancers. Limited data exist on the incidence and predictors of 30-day readmission after HCT. Objective: To measure the incidence of and risk factors associated with 30-day readmission following HCT in the United States. Design, Setting, and Participants: This cohort study examined patient data from the US population-based Nationwide Readmissions Database. All adults (age ≥18 years) who underwent autologous (auto-) or allogenic (allo-) HCT in US hospitals between January 1, 2012, and November 30, 2014, were included. The analysis was performed from June 2018 to February 2019. Main Outcomes and Measures: The main outcome was 30-day readmission rates for auto-HCT and allo-HCT. Factors associated with readmission, including baseline demographic characteristics and disease- and hospital-related characteristics (including annual case volume), were measured. Results: A total of 28356 index admissions for auto-HCT in 244 centers (191 low-volume, 38 medium-volume, and 15 high-volume centers) and 17217 index admissions for allo-HCT in 211 centers (161 low-volume, 37 medium-volume, and 13 high-volume centers) were identified during the study period. The overall 30-day readmission rates were 11.6% for auto-HCT and 24.4% for allo-HCT. The odds of readmission were significantly higher in low-volume hospitals compared with high-volume hospitals (adjusted odds ratio [aOR], 1.69; 95% CI, 1.08-2.64 for auto-HCT and aOR, 1.41; 95% CI, 1.09-1.82 for allo-HCT) but comparable to medium-volume hospitals (aOR, 1.06; 95% CI, 0.62-1.83 for auto-HCT and aOR, 1.19; 95% CI, 0.90-1.57 for allo-HCT). Other factors associated with readmission for auto-HCT included younger age (aOR for age ≥50 vs <49 years, 0.82; 95% CI, 0.68-0.98), female sex (aOR, 1.21; 95% CI, 1.06-1.36), disease type (aOR for other vs myeloma, 1.37; 95% CI, 1.06-1.77), and Elixhauser comorbidity index score (aOR for ≥20 vs 0, 1.5; 95% CI, 1.17-1.93). For allo-HCT, factors associated with readmission included disease type (aOR for acute lymphoblastic leukemia vs acute myelogenous leukemia, 1.30; 95% CI, 1.04-1.62), insurance (aOR for Medicare vs private, 1.18; 95% CI, 1.02-1.36), and Elixhauser comorbidity index score (aOR for 1-9 vs 0, 1.2; 95% CI, 1.04-1.39). Infections, neutropenic fever, and gastrointestinal symptoms were the most common reasons for readmission for both types of HCT. Conclusions and Relevance: This study found substantial rates of readmission for both types of HCT and an inverse association between hospital HCT volume and 30-day readmission. These results may provide guidance when developing quality indicators and policies penalizing hospitals for HCT readmission.
2.
Allogeneic haematopoietic cell transplantation for extranodal natural killer/T-cell lymphoma, nasal type: a CIBMTR analysis
Kanate, A. S., DiGilio, A., Ahn, K. W., Al Malki, M., Jacobsen, E., Steinberg, A., Hamerschlak, N., Kharfan-Dabaja, M., Salit, R., Ball, E., et al
British journal of haematology. 2018;182(6):916-920
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3.
Impact of obesity on clinical outcomes of elderly patients undergoing allogeneic hematopoietic cell transplant for myeloid malignancies
Voshtina, E., Szabo, A., Hamadani, M., Fenske, T. S., D'Souza, A., Chhabra, S., Saber, W., Drobyski, W. R., Hari, P., Shah, N. N.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a high-risk treatment option for patients with hematologic malignancies. Advanced age and obesity can impact outcomes after allo-HCT. Previous registry studies of all age groups found that obesity does not affect outcomes. However, obesity can accelerate age-related decline in physical function and exacerbate comorbid conditions in older patients. Studies evaluating the effect of obesity on elderly patients undergoing allo-HCT are lacking. We performed a retrospective analysis of 86 non-obese (BMI <30) and obese (BMI ≥30) patients age ≥60 who underwent allo-HCT for myeloid malignancies between January 2010 to June 2015. We found no significant differences in mean age, sex, comorbid conditions, cytogenetic risk, disease indication for transplant, or donor type between the two groups. Median overall survival (OS) was 36 months for BMI<30 patients and 24 months for BMI≥30 (p=0.55). Median progression free survival was 10.1 months in the BMI<30 group and 13.6 months in the ≥30 group (p=0.93). There was no significant difference in acute graft-versus-host disease (GVHD) and cumulative incidence of chronic GVHD at 1-year post-transplant. Among patients admitted for transplant, the mean length of stay was 25 days in BMI<30 and 26 days in BMI≥30 (p=0.64). There were more patients (34% vs 16%) with BMI≥30 who were re-admitted within 30 days of discharge (p=0.045). Our study revealed that in elderly patients with myeloid malignancies undergoing allo-HCT, clinical outcomes including OS, progression free survival, and GVHD were not affected by obesity. In elderly patients, obesity should not preclude consideration for curative allo-HCT and does not portend worse outcomes after allo-HCT.
4.
Effect of Routine Surveillance Imaging on the Outcomes of Patients With Classical Hodgkin Lymphoma After Autologous Hematopoietic Cell Transplantation
Kapke, J. T., Epperla, N., Shah, N., Richardson, K., Carrum, G., Hari, P. N., Pingali, S. R., Hamadani, M., Karmali, R., Fenske, T. S.
Clinical lymphoma, myeloma & leukemia. 2017;17(7):408-414
Abstract
BACKGROUND Patients with relapsed and refractory classical Hodgkin lymphoma (cHL) are often treated with autologous hematopoietic cell transplantation (auto-HCT). After auto-HCT, most transplant centers implement routine surveillance imaging to monitor for disease relapse; however, there is limited evidence to support this practice. PATIENTS AND METHODS In this multicenter, retrospective study, we identified cHL patients (n = 128) who received auto-HCT, achieved complete remission (CR) after transplantation, and then were followed with routine surveillance imaging. Of these, 29 (23%) relapsed after day 100 after auto-HCT. Relapse was detected clinically in 14 patients and with routine surveillance imaging in 15 patients. RESULTS When clinically detected relapse was compared with to radiographically detected relapse respectively, the median overall survival (2084 days [range, 225-4161] vs. 2737 days [range, 172-2750]; P = .51), the median time to relapse (247 days [range, 141-3974] vs. 814 days [range, 96-1682]; P = .30) and the median postrelapse survival (674 days [range, 13-1883] vs. 1146 days [range, 4-2548]; P = .52) were not statistically different. In patients who never relapsed after auto-HCT, a median of 4 (range, 1-25) surveillance imaging studies were performed over a median follow-up period of 3.5 years. CONCLUSION A minority of patients with cHL who achieve CR after auto-HCT will ultimately relapse. Surveillance imaging detected approximately half of relapses; however, outcomes were similar for those whose relapse was detected using routine surveillance imaging versus detected clinically in between surveillance imaging studies. There appears to be limited utility for routine surveillance imaging in cHL patients who achieve CR after auto-HCT.