EARLY Post-Transplant Events , Cost of Admission and Mortality, in Patients Undergoing Allogeneic Transplants from Identical Siblings, Unrelated Donors or Haploidentical Donors

Background. The outcome of allogeneic hemopoietic stem cell transplantation (HSCT) is measured in terms of graft versus host disease (GvHD), non-relapse mortality (NRM) and survival. Days of Hospital stay and number of re-admissions, are important surrogates of outcome, quality of life, and also of costs, but are usually not reported.

Aim of the study . Assess the number of days alive and outside the Hospital (DAOH) , together with the frequency of a new re-admission, in the first 100 days after transplant. Patients. We analyzed 212 patients who received an allogeneic HSCT from matched sibling (SIB) (n=64), unrelated donors (UD) (n=74) and family haploidentical donors (HAPLO) (n=74). Median age was 49 years (19-71), disease phase was in remission in 53%; diagnoses was acute leukemia (66%) , MDS (14%) chronic disorders 20%.

DAOH. The median DAOH for SIB, HAPLO and UD grafts was 78, 72 and 66 days (p=0.0001). The median DAOH for SIB patients was significantly longer than for UD patients (p=0.00002) and for HAPLO grafts (p=0.0008); the median DAOH for UD and HAPLO patients were comparable (p=0.4). Donor type was the strongest predictor of DAOH , followed by a Sorror score >2 (p=0.04).

Re-admission. Fifty four patients, of 185 discharged, required a re-admission for complications. the first cause for readmission was fever of unknown origin (54%), followed by GvHD (18,5% ) ,cystitis (8%) , relapse (7%) and respiratory problems (7%). The only factor predicting re-admission was advanced disease (p=0.01). Patients who were re-admitted to hospital within 100 days had a significantly higher risk of non relapse mortality (NRM) (25%) as compared to patient non re-admitted (5%) irrespective of the cause for re-admission (p=0.0001). In a multivariate analysis re-admission was the strongest predictor of NRM, with a risk ratio of 10.9 (p=0.0002).

Days of admission and cost. The average number of days in hospital within 100 days from transplant, was 37,6 for UD, 35,0 for HAPLO and 25,0 for SIBS (p=0.0002). The average cost of admission within 100 days from HSCT, was €69522 for UD, €64715 for HAPLO and €46225 euros for SIBS.

Conclusion. HAPLO transplants with PT-CY and UD transplants , have lower numbers of DAOH, as compared to SIB grafts, which implies longer stay in hospital and greater cost. Re-admission to Hospital within 100 days is predicted by disease phase and has a very strong impact on non relapse mortality.

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