About this Research Topic
Due to the hospitals’ aggressive microorganism environment, standard bone marrow transplantations (BMTs) are currently performed in air-filtered positive-pressured isolation rooms. In an attempt to reduce the risk of infection while improving patients’ well-being during the early phase, transplant centers have developed alternative outpatient and home care models.
As a result, transplant-related complications have diminished in incidence, and hospital bed capacity has been optimized. However, differences arise when distinct ambulatory care models are compared. Furthermore, the best approach to delivering care in these settings is not established.
For autologous BMT, advantages in neutropenic fever (NF) and infection rates have only been described in-home care (HC) models, with comparable results between outpatient (OC) and hospital care. Reduction in costs (19.32%-46.48%) has been reported in-home and outpatient models for this type of cellular therapy.
In the context of allogeneic BMT, reduced NF and infection rates, total parenteral nutrition requirements, non-relapse mortality, and costs have been associated with both OC and HC models, but only HC has been associated with a reduction in grade II-IV acute GVHD (17% vs. 44%, p<0.01) and superior overall survival (63% vs. 44% at 4 years, p=0.04), when compared to hospital care.
With respect to GVHD prophylactic regimes, the current shift in practice towards T-cell depletion (TCD) has only been tested outside hospitals in outpatient models, while the combination of TCD and HC is still formally unexplored and limited to a handful of articles with poor representation of in vivo TCD.
Regarding chimeric antigen receptor T (CAR T) cells and OC, CD19 CAR T-cell pivotal trials for non-Hodgkin lymphoma (NHL) and B-cell acute lymphoblastic leukemia (B-ALL) included patients treated in full-outpatient programs (26% in JULIET, 9% in TRANSCEND and 24% in ELIANA) or early discharge policies (minimum of 7-day hospital stay in ZUMA-1).
To make CAR T cells financially sustainable for healthcare systems, implementation of internal policies that alleviate costs, like HC programs, has become a relevant and active topic, even more now seen their fast approval in second-line large B-cell lymphoma and in relapsed/refractory multiple myeloma. However, real-world data is still limited.
We seek translational research that clarifies the underlying biology of these models’ observed benefits, as well as clinical research that improves care strategies, patient selection, prognostic stratification (ex. biomarkers), and the feasibility of these models. Technological innovations and discussions about current healthcare policies are under the scope of this collection.
Accepted Articles: Clinical trials, study protocols, original research, systematic reviews, reviews, mini-reviews, perspectives, brief research reports, hypothesis and theory, opinion, perspectives, curriculum, instruction and pedagogy, policy brief, and technology and code articles.
Studies should focus on, although not strictly limited to, the following topics:
- Strategies to implement or improve HC programs.
- Healthcare team, patients, and caregivers’ educational policies.
- Risk stratification and patient selection: biomarkers and prognostic tools.
- Cellular therapies-related complications: clinical-biological differences considering the setting (home vs. hospital care).
- Nutrition and microbiome.
- Infections.
- Innovations in technology.
- Health care policies.
As a result, transplant-related complications have diminished in incidence, and hospital bed capacity has been optimized. However, differences arise when distinct ambulatory care models are compared. Furthermore, the best approach to delivering care in these settings is not established.
For autologous BMT, advantages in neutropenic fever (NF) and infection rates have only been described in-home care (HC) models, with comparable results between outpatient (OC) and hospital care. Reduction in costs (19.32%-46.48%) has been reported in-home and outpatient models for this type of cellular therapy.
In the context of allogeneic BMT, reduced NF and infection rates, total parenteral nutrition requirements, non-relapse mortality, and costs have been associated with both OC and HC models, but only HC has been associated with a reduction in grade II-IV acute GVHD (17% vs. 44%, p<0.01) and superior overall survival (63% vs. 44% at 4 years, p=0.04), when compared to hospital care.
With respect to GVHD prophylactic regimes, the current shift in practice towards T-cell depletion (TCD) has only been tested outside hospitals in outpatient models, while the combination of TCD and HC is still formally unexplored and limited to a handful of articles with poor representation of in vivo TCD.
Regarding chimeric antigen receptor T (CAR T) cells and OC, CD19 CAR T-cell pivotal trials for non-Hodgkin lymphoma (NHL) and B-cell acute lymphoblastic leukemia (B-ALL) included patients treated in full-outpatient programs (26% in JULIET, 9% in TRANSCEND and 24% in ELIANA) or early discharge policies (minimum of 7-day hospital stay in ZUMA-1).
To make CAR T cells financially sustainable for healthcare systems, implementation of internal policies that alleviate costs, like HC programs, has become a relevant and active topic, even more now seen their fast approval in second-line large B-cell lymphoma and in relapsed/refractory multiple myeloma. However, real-world data is still limited.
We seek translational research that clarifies the underlying biology of these models’ observed benefits, as well as clinical research that improves care strategies, patient selection, prognostic stratification (ex. biomarkers), and the feasibility of these models. Technological innovations and discussions about current healthcare policies are under the scope of this collection.
Accepted Articles: Clinical trials, study protocols, original research, systematic reviews, reviews, mini-reviews, perspectives, brief research reports, hypothesis and theory, opinion, perspectives, curriculum, instruction and pedagogy, policy brief, and technology and code articles.
Studies should focus on, although not strictly limited to, the following topics:
- Strategies to implement or improve HC programs.
- Healthcare team, patients, and caregivers’ educational policies.
- Risk stratification and patient selection: biomarkers and prognostic tools.
- Cellular therapies-related complications: clinical-biological differences considering the setting (home vs. hospital care).
- Nutrition and microbiome.
- Infections.
- Innovations in technology.
- Health care policies.
Keywords: cellular therapy, bone marrow transplantation, CAR T cells, home care, outpatient care, early discharge, infections, nutrition, cellular therapy-related complications.
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
