Healthcare Utilization is High in Adult Patients Relapsing after Allogeneic Hematopoietic Cell Transplantation

摘要: Abstract Disease relapse is the leading cause of death for patients with acute leukemia (AL) and myelodysplastic syndrome (MDS) who undergo allogeneic hematopoietic cell transplantation (HCT). Relapse post-HCT associated poor prognosis; however, inpatient healthcare utilization this population unknown. Here we describe survival, intensity utilization, characteristics high resource use at end life (EOL). Adult AL/MDS underwent HCT a large regional referral center subsequent between 2005 2015 were included in retrospective study. We compared distribution demographic clinical as well over 2 years postrelapse EOL by disease-directed therapeutic interventions. created composite score summing presence any following criteria: hospital, chemotherapy, emergency department, hospitalization, intensive care unit, intubation, cardiopulmonary resuscitation, or hemodialysis last month life. Higher scores indicate more intense EOL. Multivariable linear regression analysis was used to determine variables (demographic characteristics, treatment group, advance directives documentation, palliative referral, time relapse) intensity. One hundred fifty-four included; median age 56 (interquartile range [IQR], 39 63), 55% men, 79% had AL, from 6 months (IQR, 3 10). After relapse, 28% received supportive only, 50% chemotherapy 22% plus therapy (either donor lymphocyte infusion, second HCT, infusion HCT). With exception until Karnofsky Performance Status, baseline (gender, age, race, graft-versus-host disease, year treatment) did not significantly differ group. thirty-six (88%) died within relapse; survival differed those receiving showing lower risk death. Healthcare after overall, 44% visiting department least once (22% times), 93% hospitalized (55% times, 16% 5 38% using unit (median length stay 5, days; IQR, Use even among only care. For died, mean 1.8 (standard deviation, 1.8). Most (70%) marker high-intensity hospital. In multivariable analysis, an increase (estimate -.03 (95% CI, -.06 -.003) having AL versus MDS decreased score; no other use. receipt but remains across all groups despite known prognosis. Interventions are needed minimize nonbeneficial treatments promote goal-concordant seriously ill patient population.