ArticleBone marrow transplantation2025
Prolonged length of stay in high-risk patients undergoing allogeneic stem cell transplantation: a call to action for addressing healthcare challenges.
Article in Bone marrow transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Allogeneic hematopoietic stem-cell transplantation (allo-HCT) is a potentially curative treatment for hematological diseases, but the prolonged length of stay (LOS) post-transplant remains a significant challenge. This retrospective cohort study analyzed 977 patients undergoing allo-HCT at Princess Margaret Cancer Centre between 2017 and 2022 to identify predictors of prolonged LOS and their impact on overall survival (OS) and non-relapse mortality (NRM). The median LOS within the first year was 37 days (range: 15-340). Pre-transplant predictors of prolonged LOS included HLA-mismatched donors (HR = 1.11, P < 0.001), Karnofsky Performance Scale (KPS) < 90 (HR = 1.09, P = 0.007), age >65 (HR = 1.15, P < 0.001), hematopoietic cell transplantation comorbidity index ≥3 (HR = 1.07, P = 0.04), and high disease risk index (DRI) (HR = 1.09, P < 0.01). Patients without these risk factors had a 1-year OS of 82.9%, compared to 41.9% in those with four or five factors. Post-transplant complications associated with prolonged LOS included grade III-IV acute graft-versus-host disease (HR = 1.40, P < 0.001), graft failure (HR = 1.20, P < 0.001), hemorrhagic cystitis (HR = 1.18, P < 0.001), bloodstream infections (HR = 1.19, P < 0.001), and cytomegalovirus reactivation (HR = 1.10, P < 0.001). Despite advancements in transplant protocols, age>65, mismatched donors, KPS < 90, HCT-CI ≥ 3, and high DRI remain associated with prolonged LOS and worse OS. Personalized strategies are needed to mitigate risks, reduce LOS, and improve outcomes.
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