Hospitalization For Hematopoietic Cell Transplantation Research Articles

Trajectories of patient-reported outcomes after prolonged stays for hematopoietic cell transplant.

6553 Background: Patients hospitalized for hematopoietic cell transplantation (HCT) may have prolonged length of stay (PLOS). The longitudinal effect of PLOS in this population on quality of life (QOL) and psychological distress is unknown. Methods: We conducted secondary analyses of data from three prospective studies of patients undergoing HCT (2011-2022) at three academic centers. We defined PLOS as ≥30 days for allogeneic and ≥21 days for autologous HCT from date of admission. We collected patient-reported outcomes (PROs) for QOL, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms at baseline, 2 weeks, 3 and 6 months post-HCT. We used multivariate logistic regression to assess the effect of change in PROs from baseline to week 2 on PLOS adjusting for age, transplant type, donor, and diagnosis. We then fit linear mixed effects models to characterize the trajectory of PROs by PLOS over time. Results: 593 patients (mean age 56 years) were included, the majority of whom were male (57%), white (82%), and underwent allogeneic HCT (52%). The most common diagnosis was acute leukemia (28%). Patients with PLOS (26%) were younger (57 [range 18-78 yrs], 53 [19-75 yrs], p = 0.002), had acute leukemia (26%, 34%, p = 0.001), received myeloablative conditioning (21%, 41%, p < 0.001), and underwent allogeneic HCT (50%, 60%, p < 0.001). At baseline, patients with PLOS had lower QOL (108, 102, p = 0.001) and more depression symptoms (4.4, 5.3, p = 0.02). There was no difference in baseline anxiety or PTSD symptoms. An increase in depression symptoms from baseline to week 2 was associated with greater odds of PLOS (adjusted OR = 1.08, p = 0.04). The table depicts longitudinal differences in PROs by PLOS. Compared to those without PLOS, patients with PLOS reported lower QOL (time*PLOS interaction, ∆ = -6.6, SE = 2.1, p = 0.001) and greater increase in depression symptoms (time*PLOS interaction, ∆ = 1.9, SE = 0.6, p < 0.001) at week 2. Lower QOL in those with PLOS persisted through 6 months (Table). PLOS was associated with more re-admissions (0.8, 1.1, p = 0.02) and mortality (9%, 19%, p = 0.001) within 1 year of HCT. No difference was seen in rate of relapse and severe acute or chronic graft- versus-host disease. Conclusions: Patients with PLOS experienced worse QOL and increased psychological distress. Increase in depression symptoms from admission to week 2 may be an early indicator of PLOS and supports mental health screening during the index HCT hospitalization. Patients with PLOS may benefit from enhanced supportive care during and after HCT.[Table: see text]

Coping in patients with hematologic malignancies undergoing hematopoietic cell transplantation

AbstractPatients undergoing hematopoietic cell transplantation (HCT) must cope with physical and psychological symptoms. Yet, studies examining pre-HCT coping are limited. We aimed to characterize pre-HCT coping, evaluate the association of coping with baseline quality of life (QOL) and psychological distress, and identify sociodemographic factors associated with pre-HCT coping. We conducted a cross-sectional analysis of baseline data from a multisite randomized supportive care intervention trial among patients with hematologic malignancies undergoing allogeneic or autologous HCT. We assessed patient-reported QOL, psychological distress, and coping within 72 hours of admission for HCT. We used the median split method to dichotomize coping and multivariate regression analyses to characterize the association of coping with psychological distress and QOL. Of patients awaiting HCT (n = 360; mean age, 55.4 years; 49.7% autologous), 43.5% were high users of approach-oriented coping, whereas 31.3% were high users of avoidant coping. Patients reported high use of emotional support (60.9%), acceptance (51.2%), self-blame (33%), and denial (31.3%). Older age (≥65 years) was associated with less frequent use of avoidant coping (odds ratio, 0.5; P = .01). Approach-oriented coping was associated with better pre-HCT QOL (Beta(B) = 6.7; P = .001), and lower depression (B = −1.1; P = .001) and anxiety (B = −0.9; P = .02) symptoms. Avoidant coping was associated with worse pre-HCT QOL (B = −13.3; P < .001) and symptoms of depression (B = 1.9; P < .001), anxiety (B = 3.1; P < .001), and posttraumatic stress disorder (B = 8.1; P < .001). Pre-HCT coping is strongly associated with psychological distress and QOL. These data support the need for interventions to address coping during HCT hospitalization. This clinical trial was registered at www.clinicaltrials.gov as #NCT03641378.

Coping in Patients with Hematologic Malignancies Undergoing Hematopoietic Cell Transplantation

Background Patients undergoing hematopoietic cell transplantation (HCT) must cope with immense physical and psychological symptoms during HCT hospitalization, which contribute to a dramatic deterioration in quality of life (QOL). Yet, studies examining pre-HCT coping strategies are limited. We aimed to characterize use of pre-HCT coping strategies, to identify sociodemographic and clinical factors associated with coping strategy use, and to investigate the association of coping strategy use with pre-HCT QOL and psychological distress. Methods We conducted a secondary analysis of baseline data from a multi-site randomized controlled trial evaluating a supportive care intervention for patients with hematologic malignancies undergoing allogeneic or autologous HCT (NCT#03641378). From 10/2018 - 07/2022, the trial enrolled consecutive adults (age ≥ 18) with hematologic cancers undergoing HCT at three tertiary care academic centers. Prior to HCT, we assessed QOL (Functional Assessment of Cancer Therapy - Bone Marrow Transplant), psychological symptoms (Hospital Anxiety and Depression Scale and Post Traumatic Stress Disorder (PTSD) - Civilian Version), and coping (Brief COPE). We categorized coping as either “approach-oriented” (active coping, use of emotional support, positive reframing, acceptance) or “avoidant” (behavioral disengagement, denial, and self-blame). We used the median split method to categorize high and low use of approach-oriented and avoidant coping. Univariate logistic regression was used to identify sociodemographic and clinical factors associated with high use of coping strategies. Multivariate linear regression was used to measure associations of coping strategy use with QOL and psychological distress. Results Of pre-HCT patients (n=360), the majority were male (62.8%), identified as White (77.5%), were younger than 65 (73.6%), and had received at least some college education (78.9%). A minority were unemployed due to disability from illness (29.2%). Approximately half received autologous HCT (n=178, 49.4%). Figure 1 displays the proportion of patients scoring as high utilizers of individual coping strategies. While 31.3% were high utilizers of avoidant coping, 43.5% were high utilizers of approach-oriented coping. Notably, 43 (11.9%) patients identified as high utilizers of both approach-oriented and avoidant coping. No sociodemographic or clinical factors were associated with use of approach-oriented coping. Older age (&amp;gt;65 years, OR=0.9, p=0.01) and higher income (&amp;gt;$100K, OR=0.90, p=0.04) were associated with less frequent use of avoidant coping. Female gender (OR=1.11, p=0.03) and disabled employment status (OR=1.11, p=0.05) were associated with increased likelihood of high use of avoidant coping. Table 1 displays adjusted associations between approach-oriented and avoidant coping strategies and patient-reported outcomes. High use of approach-oriented coping was associated with better pre-HCT QOL (B=6.4, p&amp;lt;0.001) and lower depression (B=-1.1, p=0.001) and anxiety (B=-0.9, p=0.02) symptoms. High use of avoidant coping was associated with worse pre-HCT QOL (B=-11.7, p&amp;lt;0.001) and symptoms of depression (B=1.9, p&amp;lt;0.001), anxiety (B=3.1, p&amp;lt;0.001), and PTSD (B=8.1, p&amp;lt;0.001). Conclusions Prior to HCT, patients frequently employ approach-oriented and avoidant coping strategies. Key sociodemographic factors including age, gender, income level, and employment status were associated with avoidant coping. Patients with high use of approach-oriented coping reported higher baseline QOL and lower psychological distress, while those with high use of avoidant coping strategies reported worse QOL and psychological distress. These data suggest that supportive care interventions which enhance approach-oriented coping and mitigate avoidant coping in pre-HCT populations may improve QOL and reduce psychological distress

Health-related quality of life predicts length of hospital stay and survival rates for pediatric patients receiving allogeneic hematopoietic cell transplantation.

We examined the association between health-related quality of life (HRQoL) of pediatric patients during hospitalization for allogeneic hematopoietic cell transplantation (HCT) and length of hospital stay, and 1-year survival. Primary family caregivers were proxy-assessors for the Pediatric Quality of Life (PedsQL) Stem Cell Transplant Module at three time points: 5-days pre-HCT (T0); 14-days post-HCT (engraftment, T1); and 1-week before hospital discharge (T2). Cox regression analyses determined predictors of the overall 1-year survival after allogeneic HCT. Thirty-nine eligible caregivers completed all assessments. The mean age of the pediatric patients was 9.07years (SD = 5.2). PedsQL Stem Cell Transplant Module scores decreased from 71.33 (SD = 13.26) at T0 to 55.41(SD = 13.05) at T1 (p < 0.001) and increased to 68.46 (SD = 13.97) at T2 (p < 0.001). There was no significant difference between scores at T0 and T2. Longer length of hospital stay was associated with children who were younger and had greater relative changes in scores on the caregiver-proxy PedsQL Stem Cell Transplant Module from T0 to T1. PedsQL Stem Cell Transplant Module scores ≥ 58.07 at T2 were associated with higher 1-year survival rates (Hazard Ratio = 0.12, 95% Confidence Interval = 0.02-0.78; p = 0.03). Our findings suggest that assessment of HRQoL during early HCT can add prognostic value beyond demographic and HCT factors. Understanding the HRQoL status during hospitalization for HCT could help identify pediatric patients with low prospects of 1-year survival in order to provide support interventions to improve HRQoL and survival rates.

Diarrheal Morbidity During Hematopoietic Cell Transplantation: The Diagnostic Yield of Stool Cultures.

IntroductionDiarrhea affects a significant proportion of patients undergoing hematopoietic cell transplantation (HCT). We explored the diagnostic yield of stool cultures for enteric pathogens among patients undergoing HCT.MethodsThis is a single-center, retrospective study. Between 5/2007 and 4/2020, consecutive patients who underwent HCT were included if inpatient bacterial stool cultures were collected. Patient characteristics, results, and timing of stool cultures obtained during hospitalization were collected.ResultsA total of 1072 individuals underwent autologous (n = 603) and allogeneic (n = 469) HCT. Overall, 947 stool culture samples were obtained from 561 (52%) patients with diarrheal illness during hospitalization for HCT. Most (99%) samples were obtained beyond 3 days of admission, mainly (77%) during neutropenia. Overall, only four (0.42%) (autologous, n = 3; allogeneic, n = 1) patients had a positive stool culture and in all cases Campylobacter spp. were the pathogens identified. The number of stool cultures needed-to-test to diagnose one case of bacterial infection was 237. The cost of diagnosing one case of bacterial diarrhea was US $8770. Patients with a positive stool culture did not have discerning characteristics.ConclusionsIn our experience, the yield of stool cultures for enteropathogens in patients undergoing HCT is extremely low and thus should be avoided in most cases.

195. Economic and Clinical Burden of Respiratory Virus Infections in Allogeneic Hematopoietic Cell Transplantation Recipients

BackgroundRespiratory viruses (RV), including respiratory syncytial virus (RSV), influenza, parainfluenza virus (PIV), and human metapneumovirus (HMPV), frequently lead to serious complications such as lower respiratory tract infections and death in allogeneic hematopoietic cell transplantation (HCT) recipients. We used a large US claims database to compare the total reimbursement (TR), health resource utilization (HRU) and clinical outcomes between HCT patients with and without RV infections (RVI).MethodsWe used the Decision Resources Group Real World Evidence Data Repository to identify HCT recipients with date of service for the procedure from 1/1/2012-12/31/2017. We estimated the reimbursements from submitted charges using a reimbursement to charge ratio of 0.425. We examined the study outcomes in the year following HCT in patients with and without RVI. We also used a generalized linear model to determine adjusted TR stratified by the presence or absence of any acute or chronic graft-versus-host diseases (GVHD) after adjusting for age, health plan, underlying disease, stem cell source, number of comorbidities, baseline costs, and follow-up time.ResultsThe study included 13,363 patients, representing 22% of HCTs reported to CIBMTR for the study period, of which 1,368 (10%) were coded with an RVI in the year following HCT: 578 (4%) RSV, 687 (5%) influenza, 166 (1%) PIV, and 181 (1%) HMPV. Unadjusted median TR were $132,395 higher for any RVI ($139,439 RSV, $101,963 influenza, $185,041 PIV and $248,029 HMPV) compared to those without RVI (Table 1). Adjusted TR were significantly higher for patients with any RVI compared to patients without that infection (p< .01) with or without GVHD (Figure 1). Patients with any RVI had significantly longer length of stay (LOS) for the HCT hospitalization, readmission rate and LOS after HCT hospitalization compared to patients without RVI (p< 0.05) (Table 2). A significantly higher proportion of patients with any RVI had pneumonia as compared to patients without that infection, irrespective of presence of GVHD (p< .0001).Table 1: Total healthcare reimbursement within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections Figure 1: Adjusted total reimbursements within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections Table 2: Health resource utilization within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections ConclusionAllogeneic HCT patients with RVI have a significantly higher burden of TR, health resource utilization and worse clinical outcomes such as pneumonia during one year of undergoing HCT, regardless of the presence of GVHD.Disclosures Michael G. Ison, MD MS, AlloVir (Consultant) Francisco M. Marty, MD, Allovir (Consultant)Amplyx (Consultant)Ansun (Scientific Research Study Investigator)Avir (Consultant)Cidara (Scientific Research Study Investigator)F2G (Consultant, Scientific Research Study Investigator)Kyorin (Consultant)Merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)New England Journal of Medicine (Other Financial or Material Support, Honorarium for Video)Regeneron (Consultant, Scientific Research Study Investigator)ReViral (Consultant)Scynexis (Scientific Research Study Investigator)Symbio (Consultant)Takeda (Scientific Research Study Investigator)United Medical (Consultant)WHISCON (Scientific Research Study Investigator) Seung Hyun Moon, MD, MPA, AlloVir (Employee, Shareholder) Zhiji Zhang, MS, AlloVir (Independent Contractor) Aastha Chandak, PhD, AlloVir (Independent Contractor)

Diarrheal Morbidity in Patients Undergoing Hematopoietic Cell Transplantation - the Diagnostic Yield of Stool Cultures

Diarrhea affects a significant proportion of patients undergoing hematopoietic cell transplantation (HCT). In this single center retrospective study, we explored the diagnostic yield of stool cultures for enteric pathogens among patients undergoing HCT. Between May 2007 and April 2020, a total of 1072 individuals underwent autologous (n=603) and allogeneic (n=469) HCT. Overall, 947 stool culture samples were obtained from 561 (52%) patients with diarrheal illness during hospitalization for HCT. Most (99%) samples were obtained beyond 3 days of admission and mainly (77%) during neutropenia. Overall, only four (autologous HCT, n=3; allogeneic HCT, n=1) patients were diagnosed with positive stool culture (0.42%) and in all cases, Campylobacter spp. was the pathogen identified. All isolates grew from the first stool culture obtained. The number of stool cultures needed-to-test to diagnose one case of bacterial infection was 237. The cost of diagnosing one case of bacterial infectious diarrhea was 8,770 US dollars. The median time from admission to positive stool culture sample was 12 (range, 7 to 13) days. Patients with a positive stool culture did not have discerning clinical or laboratory characteristics. In conclusion, according to our experience, the yield of stool cultures for enteropathogens in patients undergoing HCT is extremely low and thus should be avoided in most cases. Disclosures Wolach: Amgen: Other: Fees for lectures and Consultancy; Janssen: Other: Fees for lectures and Consultancy; Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Other: Fees for lectures and Consultancy; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Fees for lectures and Consultancy, Research Funding; Astellas: Consultancy, Honoraria, Other: Fees for lectures and Consultancy.

Updated Analysis: Novel Machine-Learning-Based Sepsis Prediction Model for Patients Undergoing Hematopoietic Stem Cell Transplantation (Early Sepsis Prediction/Identification for Transplant Recipients: ESPRIT)

Updated Analysis: Novel Machine-Learning-Based Sepsis Prediction Model for Patients Undergoing Hematopoietic Stem Cell Transplantation (Early Sepsis Prediction/Identification for Transplant Recipients: ESPRIT)

Effect of inpatient palliative care on supportive care measures in patients undergoing hematopoietic cell transplantation (HCT).

70 Background: Inpatient palliative care integrated with transplant care has been shown to improve patient-reported quality of life (QOL), symptom burden, and psychological distress during hospitalization for HCT. However, the impact of palliative care on supportive care practices during HSCT remains unknown. Methods: This secondary analysis is based on a single-site randomized clinical trial of 160 patients with hematologic malignancies undergoing HSCT between 8/2014 and 1/2016. Participants received either inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). We used the electronic health record to obtain data on supportive care measures during HSCT including the use of patient-controlled analgesia (PCA), intravenous pain medications, atypical antipsychotics (used to treat nausea/anxiety), psychostimulants, antidepressants, hypnotics, and the use of standing orders (as opposed to as needed ‘PRN’) for supportive care medications. We compared the proportion of subjects in each group receiving these supportive care measures using Fisher’s exact test. Results: Patients randomized to the palliative care intervention were more likely to use PCA (32.1% vs. 15.19%, P = 0.015), and atypical antipsychotics (35.8% vs. 17.7%, P = 0.012) compared to those receiving transplant care alone. Intervention participants were also more likely to have standing orders for their supportive care medications (74.1% vs. 56.9%, P = 0.030) compared to those receiving transplant care alone. Study groups did not differ in the of intravenous pain medications, psychostimulants, antidepressants, or hypnotics. Conclusions: Patients receiving inpatient integrated palliative and transplant care were more likely to utilize PCA and atypical antipsychotics during HCT compared to those receiving transplant care alone. Future work should examine whether these differences in supportive care practices mediate the effect of the palliative care intervention on patient-reported outcomes. Clinical trial information: NCT02207322.

Factors Influencing Patients' Intention to Perform Physical Activity During Hematopoietic Cell Transplantation.

To examine theoretical and medical variables influencing a patient's intention to perform physical activity during hospitalization for hematopoietic cell transplantation (HCT). 54 patients undergoing HCT at the Seidman Cancer Center in Cleveland, Ohio. A longitudinal, prospective cohort design was used. Instruments included the Self-Report Habit Index, tailored to assess exercise habit, the Memorial Symptom Assessment Scale-Short Form, and an investigator-constructed survey of intention, attitude, control, and subjective norm toward physical activity. Descriptive statistics, univariate logistic regression, and linear regression were used. Intention for physical activity remained high at all time points. Previous exercise habits were not related to intention. Inverse relationships between symptom distress and the theoretical constructs that influence intention occurred at the critical time points of nadir and discharge during transplantation. Nurses should reinforce physical activity regardless of exercise habits. Symptom distress may influence physical activity differently during the transplantation trajectory.

Inpatient Healthcare Resource Utilization, Costs, and Mortality in Adult Patients with Acute Graft-versus-Host Disease, Including Steroid-Refractory or High-Risk Disease, following Allogeneic Hematopoietic Cell Transplantation.

Acute graft-versus-host disease (GVHD) contributes to poor outcomes following allogeneic hematopoietic cell transplantation (HCT). Data are limited regarding the economic burden of acute GVHD, particularly steroid-refractory or high-risk (SR/HR) disease. This retrospective analysis of the Premier Healthcare Database reports inpatient healthcare resource utilization (HCRU), costs, and mortality during initial hospitalization for allogeneic HCT and through 100 days post-HCT among patients who developed acute GVHD, including a subgroup with SR/HR disease, compared with patients without GVHD. The analysis included adults discharged for first HCT between January 1, 2011, and June 30, 2016 (acute GVHD, n=906; SR/HR acute GVHD, n=158; no GVHD, n=1529). During the initial hospitalization for HCT, patients with acute GVHD and SR/HR acute GVHD (n=455 and 125, respectively) had significantly longer median lengths of stay (31 and 46 days versus 24 days) and higher median total costs ($153,849 and $205,880 versus $97,417) versus patients with no GVHD (n=1529; P < .0001 for all). During the 100-day post-HCT period, patients with acute GVHD and SR/HR acute GVHD had higher readmission rates (78.3% and 77.2% versus 28.3%; P < .0001) and inpatient mortality rates (20.2% and 35.4% versus 8.9%; P < .0001) versus patients with no GVHD. In summary, acute GVHD, especially SR/HR disease, is associated with longer inpatient stays, higher readmission rates, and higher inpatient mortality compared with no GVHD.

Venous thromboembolism (VTE) in multiple myeloma (MM) patients undergoing autologous hematopoietic cell transplantation (HCT).

e19503 Background: HCT is commonly used for consolidation for MM patients (pts). These pts have a significant risk of VTE and may potentially be candidates for prophylactic anticoagulation. However, incidence and outcomes of VTE in peri-transplant period remain unclear for MM pts. Methods: Between 2006 and 2016, 160 MM pts underwent autologous HCT at our institution. Peri-transplant period was defined as between initiation of stem cell collection (SCC) and 30 days after discharge from HCT hospitalization. No pts received routine VTE prophylaxis. Clinically significant bleeding was defined as a bleeding event that led to a specific clinical intervention, such as transfusion. We used Cox regression to assess risk factors for peri-transplant VTE. We compared overall survival (OS) using log-rank test. Results: In peri-transplant period, 18 symptomatic VTE occurred in 17 pts (10.6%; 95% CI 7 - 17). Twelve (7.5%) were catheter-related, 4 (2.5%) were non-catheter-related deep venous thrombosis, and 2 (1.3%) were pulmonary emboli. Seven VTE occurred between SCC and HCT. Importantly, among 11 VTE after HCT, only 1 VTE occurred before neutrophil engraftment and only 2 VTE occurred at a platelet count less than 50 x 109/L (median: 138, range: 30 - 464). Clinically significant bleeding occurred in 9 (5.6%) pts during peri-transplant period, without any fatal bleeding. Multivariate analysis was performed including; treatment with immunomodulatory drugs (p = 0.008), HCT comorbidity index ≥ 2 (p = 0.036), age &gt; 60 (p = 0.07), smoking at any time (p = 0.07), BMI &gt; 30 at HCT (p = 0.19), partial remission at HCT (p = 0.20), ISS stage 3 at diagnosis (p = 0.37). At median follow-up of 31 months since HCT, 3-year OS for pts with and without peri-transplant VTE was 58.8% (CI 38% - 91%) and 77.6% (CI 70% - 86%), respectively (p = 0.11). Conclusions: Peri-transplant symptomatic VTE was highly prevalent in our cohort of pts with MM and vast majority of VTE events occurred either between SCC and HCT or after neutrophil engraftment. Our findings indicate that routine VTE prophylaxis in peri-transplant period should be considered for MM pts and timing of VTE prophylaxis can be tailored to optimize balance between safety and efficacy.

Costs of Hospitalization for Hematopoietic Cell Transplantation (HCT) in the United States (U.S.): A Pilot Study Using a Large National Commercial Payor Database

Costs of Hospitalization for Hematopoietic Cell Transplantation (HCT) in the United States (U.S.): A Pilot Study Using a Large National Commercial Payor Database