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GRAPEVINE, TEXAS—Acute leukemia patients who undergo cord blood (CB) transplant have longer hospital stays than patients who receive other types of transplant, new research indicates.
The study also suggests the length of stay (LOS) is similar whether patients receive double or single CB grafts.
So it seems strategies are needed to decrease hospital stay after CB transplant, particularly as LOS drives the cost of care, said Karen K. Ballen, MD, of Massachusetts General Hospital in Boston.
Dr Ballen presented this research at the 2014 BMT Tandem Meetings as abstract 104.*
She and her colleagues studied patients diagnosed with acute leukemias who were transplanted at US centers and reported to the CIBMTR between 2008 and 2011.
Patients were eligible if they received an unrelated single or double CB transplant, an 8/8 matched unrelated donor (MUD) transplant with peripheral blood (PB) or bone marrow (BM), or a 7/8 MUD PB or BM graft.
In all, 1796 patients met these criteria. The researchers evaluated patients’ total hospital LOS in the first 100 days after transplant, compared LOS among graft sources, and looked for predictors of LOS in the first 100 days.
The team stratified patients according to age and conditioning regimen. Pediatric patients were classified as those aged 18 and younger, and they only received myeloablative conditioning (MAC). Adults received either MAC or reduced-intensity conditioning (RIC).
Pediatric patients
In a univariate analysis of the 368 pediatric patients, there was no significant difference in 100-day survival according to graft source (P=0.13).
However, patients who received single or double CB grafts had a significantly higher median total LOS by day 100 than patients who received 8/8 MUD BM, which was the only other graft source in this patient group (P=0.03).
Patients who received CB grafts also had significantly fewer days in which they were alive and not in the hospital (P=0.005).
“We wanted to account for patients whose length of stay was short because they actually died early after transplant,” Dr Ballen explained. “Therefore, we did an analysis of days alive and not in the hospital.”
In a multivariate analysis, pediatric patients who received CB grafts had significantly fewer days alive and out of the hospital than those who received 8/8 MUD BM (P=0.03).
Other factors associated with fewer days alive and out of the hospital were CMV positivity (P=0.01), black race (P=0.01), and a Karnofsky performance score of less than 80 (P=0.03).
Adults on MAC
In a univariate analysis of the 768 adults who received MAC, recipients of CB grafts had significantly worse 100-day survival than their peers (P<0.001), as well as a longer median LOS by day 100 (P<0.001) and fewer days alive and not in the hospital (P<0.001).
In a multivariate analysis, adults who received MAC had significantly fewer days alive and out of the hospital if they received CB grafts than if they received 8/8 MUD BM (P<0.001), 8/8 MUD PB (P<0.001), or 7/8 MUD PB (P=0.01), but not 7/8 MUD BM (P=0.49).
Other factors associated with fewer days alive and out of the hospital were black race (P=0.04), having acute lymphocytic leukemia rather than acute myeloid leukemia (P=0.01), and age 18-25 (P=0.01).
“We were a little surprised at these results—that the older patients actually spent more time alive and out of the hospital,” Dr Ballen said.
Adults on RIC
In a univariate analysis of the 660 adults who received RIC, recipients of CB grafts had significantly worse 100-day survival than their peers (P=0.017), as well as a longer median LOS by day 100 (P<0.001) and fewer days alive and not in the hospital (P<0.001).
In a multivariate analysis, adults who received RIC had significantly fewer days alive and out of the hospital if they received CB grafts than if they received 8/8 MUD PB (P<0.001) or 7/8 MUD PB (P<0.001).
No other factors were associated with the number of days these patients were alive and out of the hospital.
These results, when taken together, suggest that CB grafts are associated with longer hospital stays, independent of other factors.
“The majority of cost appears to be driven by the number of days in the hospital,” Dr Ballen noted. “So these data may be important for resource allocation, especially given the recent changes in the US healthcare system.” 
*Information in the abstract differs from that presented at the meeting.
GRAPEVINE, TEXAS—Acute leukemia patients who undergo cord blood (CB) transplant have longer hospital stays than patients who receive other types of transplant, new research indicates.
The study also suggests the length of stay (LOS) is similar whether patients receive double or single CB grafts.
So it seems strategies are needed to decrease hospital stay after CB transplant, particularly as LOS drives the cost of care, said Karen K. Ballen, MD, of Massachusetts General Hospital in Boston.
Dr Ballen presented this research at the 2014 BMT Tandem Meetings as abstract 104.*
She and her colleagues studied patients diagnosed with acute leukemias who were transplanted at US centers and reported to the CIBMTR between 2008 and 2011.
Patients were eligible if they received an unrelated single or double CB transplant, an 8/8 matched unrelated donor (MUD) transplant with peripheral blood (PB) or bone marrow (BM), or a 7/8 MUD PB or BM graft.
In all, 1796 patients met these criteria. The researchers evaluated patients’ total hospital LOS in the first 100 days after transplant, compared LOS among graft sources, and looked for predictors of LOS in the first 100 days.
The team stratified patients according to age and conditioning regimen. Pediatric patients were classified as those aged 18 and younger, and they only received myeloablative conditioning (MAC). Adults received either MAC or reduced-intensity conditioning (RIC).
Pediatric patients
In a univariate analysis of the 368 pediatric patients, there was no significant difference in 100-day survival according to graft source (P=0.13).
However, patients who received single or double CB grafts had a significantly higher median total LOS by day 100 than patients who received 8/8 MUD BM, which was the only other graft source in this patient group (P=0.03).
Patients who received CB grafts also had significantly fewer days in which they were alive and not in the hospital (P=0.005).
“We wanted to account for patients whose length of stay was short because they actually died early after transplant,” Dr Ballen explained. “Therefore, we did an analysis of days alive and not in the hospital.”
In a multivariate analysis, pediatric patients who received CB grafts had significantly fewer days alive and out of the hospital than those who received 8/8 MUD BM (P=0.03).
Other factors associated with fewer days alive and out of the hospital were CMV positivity (P=0.01), black race (P=0.01), and a Karnofsky performance score of less than 80 (P=0.03).
Adults on MAC
In a univariate analysis of the 768 adults who received MAC, recipients of CB grafts had significantly worse 100-day survival than their peers (P<0.001), as well as a longer median LOS by day 100 (P<0.001) and fewer days alive and not in the hospital (P<0.001).
In a multivariate analysis, adults who received MAC had significantly fewer days alive and out of the hospital if they received CB grafts than if they received 8/8 MUD BM (P<0.001), 8/8 MUD PB (P<0.001), or 7/8 MUD PB (P=0.01), but not 7/8 MUD BM (P=0.49).
Other factors associated with fewer days alive and out of the hospital were black race (P=0.04), having acute lymphocytic leukemia rather than acute myeloid leukemia (P=0.01), and age 18-25 (P=0.01).
“We were a little surprised at these results—that the older patients actually spent more time alive and out of the hospital,” Dr Ballen said.
Adults on RIC
In a univariate analysis of the 660 adults who received RIC, recipients of CB grafts had significantly worse 100-day survival than their peers (P=0.017), as well as a longer median LOS by day 100 (P<0.001) and fewer days alive and not in the hospital (P<0.001).
In a multivariate analysis, adults who received RIC had significantly fewer days alive and out of the hospital if they received CB grafts than if they received 8/8 MUD PB (P<0.001) or 7/8 MUD PB (P<0.001).
No other factors were associated with the number of days these patients were alive and out of the hospital.
These results, when taken together, suggest that CB grafts are associated with longer hospital stays, independent of other factors.
“The majority of cost appears to be driven by the number of days in the hospital,” Dr Ballen noted. “So these data may be important for resource allocation, especially given the recent changes in the US healthcare system.”
*Information in the abstract differs from that presented at the meeting.
GRAPEVINE, TEXAS—Acute leukemia patients who undergo cord blood (CB) transplant have longer hospital stays than patients who receive other types of transplant, new research indicates.
The study also suggests the length of stay (LOS) is similar whether patients receive double or single CB grafts.
So it seems strategies are needed to decrease hospital stay after CB transplant, particularly as LOS drives the cost of care, said Karen K. Ballen, MD, of Massachusetts General Hospital in Boston.
Dr Ballen presented this research at the 2014 BMT Tandem Meetings as abstract 104.*
She and her colleagues studied patients diagnosed with acute leukemias who were transplanted at US centers and reported to the CIBMTR between 2008 and 2011.
Patients were eligible if they received an unrelated single or double CB transplant, an 8/8 matched unrelated donor (MUD) transplant with peripheral blood (PB) or bone marrow (BM), or a 7/8 MUD PB or BM graft.
In all, 1796 patients met these criteria. The researchers evaluated patients’ total hospital LOS in the first 100 days after transplant, compared LOS among graft sources, and looked for predictors of LOS in the first 100 days.
The team stratified patients according to age and conditioning regimen. Pediatric patients were classified as those aged 18 and younger, and they only received myeloablative conditioning (MAC). Adults received either MAC or reduced-intensity conditioning (RIC).
Pediatric patients
In a univariate analysis of the 368 pediatric patients, there was no significant difference in 100-day survival according to graft source (P=0.13).
However, patients who received single or double CB grafts had a significantly higher median total LOS by day 100 than patients who received 8/8 MUD BM, which was the only other graft source in this patient group (P=0.03).
Patients who received CB grafts also had significantly fewer days in which they were alive and not in the hospital (P=0.005).
“We wanted to account for patients whose length of stay was short because they actually died early after transplant,” Dr Ballen explained. “Therefore, we did an analysis of days alive and not in the hospital.”
In a multivariate analysis, pediatric patients who received CB grafts had significantly fewer days alive and out of the hospital than those who received 8/8 MUD BM (P=0.03).
Other factors associated with fewer days alive and out of the hospital were CMV positivity (P=0.01), black race (P=0.01), and a Karnofsky performance score of less than 80 (P=0.03).
Adults on MAC
In a univariate analysis of the 768 adults who received MAC, recipients of CB grafts had significantly worse 100-day survival than their peers (P<0.001), as well as a longer median LOS by day 100 (P<0.001) and fewer days alive and not in the hospital (P<0.001).
In a multivariate analysis, adults who received MAC had significantly fewer days alive and out of the hospital if they received CB grafts than if they received 8/8 MUD BM (P<0.001), 8/8 MUD PB (P<0.001), or 7/8 MUD PB (P=0.01), but not 7/8 MUD BM (P=0.49).
Other factors associated with fewer days alive and out of the hospital were black race (P=0.04), having acute lymphocytic leukemia rather than acute myeloid leukemia (P=0.01), and age 18-25 (P=0.01).
“We were a little surprised at these results—that the older patients actually spent more time alive and out of the hospital,” Dr Ballen said.
Adults on RIC
In a univariate analysis of the 660 adults who received RIC, recipients of CB grafts had significantly worse 100-day survival than their peers (P=0.017), as well as a longer median LOS by day 100 (P<0.001) and fewer days alive and not in the hospital (P<0.001).
In a multivariate analysis, adults who received RIC had significantly fewer days alive and out of the hospital if they received CB grafts than if they received 8/8 MUD PB (P<0.001) or 7/8 MUD PB (P<0.001).
No other factors were associated with the number of days these patients were alive and out of the hospital.
These results, when taken together, suggest that CB grafts are associated with longer hospital stays, independent of other factors.
“The majority of cost appears to be driven by the number of days in the hospital,” Dr Ballen noted. “So these data may be important for resource allocation, especially given the recent changes in the US healthcare system.”
*Information in the abstract differs from that presented at the meeting.