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<p>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, <i>P</i> &lt; 0.001), Karnofsky Performance Scale (KPS) &lt; 90 (HR = 1.09, <i>P</i> = 0.007), age &gt;65 (HR = 1.15, <i>P</i> &lt; 0.001), hematopoietic cell transplantation comorbidity index ≥3 (HR = 1.07, <i>P</i> = 0.04), and high disease risk index (DRI) (HR = 1.09, <i>P</i> &lt; 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, <i>P</i> &lt; 0.001), graft failure (HR = 1.20, <i>P</i> &lt; 0.001), hemorrhagic cystitis (HR = 1.18, <i>P</i> &lt; 0.001), bloodstream infections (HR = 1.19, <i>P</i> &lt; 0.001), and cytomegalovirus reactivation (HR = 1.10, <i>P</i> &lt; 0.001). Despite advancements in transplant protocols, age&gt;65, mismatched donors, KPS &lt; 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.</p>

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Prolonged length of stay in high-risk patients undergoing allogeneic stem cell transplantation: a call to action for addressing healthcare challenges

  • 期刊论文

  • 发表日期：

    2025年6月3日

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  • Ayman Sayyed,
  • Igor Novitzky-Basso,
  • Mats Remberger,
  • Susan Clarke,
  • Carol Chen,
  • Eshrak Al-Shaibani,
  • Dennis D. H. Kim,
  • Auro Viswabandya,
  • Rajat Kumar,
  • Wilson Lam,
  • Arjun D. Law,
  • Armin Gerbitz,
  • Ivan Pasic,
  • Fotios V. Michelis,
  • Jonas Mattsson

摘要

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.