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REVIEW article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1384137
This article is part of the Research Topic Methods in Alloimmunity and Transplantation: 2023 View all 10 articles

Lower triggering of inflammatory cytokines may pave the way for better outcomes in allogeneic hematopoietic cell transplantation recipients treated at home in contrast to isolation in the hospital-The Karolinska Experience

Provisionally accepted
Olle T. Ringden Olle T. Ringden 1*Britt-marie Svahn Britt-marie Svahn 1Guido Moll Guido Moll 2Behnam Sadeghi Behnam Sadeghi 1,3
  • 1 Translational Cell Therapy Research (TCR), Division of Paediatrics, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • 2 Charité Center for Global Health, Charité Universitätsmedizin Berlin, Berlin, Baden-Württemberg, Germany
  • 3 Karolinska Institutet (KI), Solna, Sweden

The final, formatted version of the article will be published soon.

    After allogeneic hematopoietic cell transplantation (Allo-HCT) and conditioning, patients are typically placed in isolated hospital rooms to prevent neutropenic infections. Since 1998, we've offered an alternative: home care for patients living within a one to two-hour drive of the hospital. This approach includes daily visits by an experienced nurse and daily phone consultations with a unit physician. When necessary, patients receive transfusions, intravenous antibiotics, and total parenteral nutrition at home. Our initial report compared 36 home care patients with 54 hospital-treated controls. Multivariate analysis showed that home care patients were discharged earlier to outpatient clinics, required fewer days of total parenteral nutrition, had less acute graft-versus-host disease (GVHD) grade II-IV, and experienced lower transplantation-related mortality (TRM) and costs. Long-term follow-up showed similar chronic GVHD and relapse rates in both groups, with improved survival rates in the home care group. A subsequent comparison of 146 home care patients with hospital-treated controls indicated that lower grades of acute GVHD (grades 0-I) were associated with home care and longer home stays. Home care was also found to be safe and beneficial for children and adolescents. Over two decades, 252 patients received home care post-Allo-HCT without any at-home fatalities. Ten-year outcomes showed a 14% TRM and a 59% survival rate. Comparing cytokine profiles, we found higher levels of GM-CSF, IFN-γ, IL-13, G-CSF, IL-5, and IL-2, and lower VEGF in hospital-treated patients, which may contribute to acute GVHD grades II-IV. A report from another center also confirmed a reduced risk of acute GVHD grades II-IV for patients treated at home [1]. In conclusion, home-based treatment following Allo-HCT yields promising outcomes.

    Keywords: Allogeneic hematopoietic cell transplantation, graft-versus-host disease, home care, Cytokines, Oral nutrition

    Received: 08 Feb 2024; Accepted: 24 Jul 2024.

    Copyright: © 2024 Ringden, Svahn, Moll and Sadeghi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Olle T. Ringden, Translational Cell Therapy Research (TCR), Division of Paediatrics, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Stockholm, Sweden

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.