Phase II: A controlled study of microbiome and stem cell transplantation medical home care compared to standard hospital care

Blood Cancer
Nelson Chao, MD, MBA
Duke University School of Medicine

After a hematopoietic stem cell transplant, which is the treatment of choice for a variety of malignant and non-malignant diseases, the patients are isolated in the hospital because their immune systems are so weak and depleted. The healthy bacteria levels in their bowels are monitored so they can be given necessary supplements. Despite aggressive measures, some patients succumb to graft-versus-host disease.

It was a surprise, therefore, when it was found that the patients who were able to go home for brief visits during their post-transplant hospital stays had improved gut bacteria levels, better appetites and better quality of life survey results.

This two year pilot will compare 30 patients who continue their care at home to 60 patients who continue their care in the hospital. Those who are at home will be closely monitored. If this study shows comparable or better results for those who stay home, it may point to a treatment option with better benefits for less cost. [Awarded 2013]

Clinical Summary:

Graft versus host disease (GVHD) is a frequent complication of hematopoietic stem cell transplantation (HCT), leading to morbidity and mortality shortly after HCT. During the critical phase, patients are kept in protected environment in the hospital, yet infectious complications remain common partially due to poor nutrition and decreased gut microbiota. As one of the first and only, this team has been using home care extensively to provide better care for HCT patients at reduced cost. It is hypothesized that individuals who are treated at home have significantly more gut microbiome and better outcomes compared to those who are treated in the hospital. This approach of patient-centered medical home for treatments is a potential significant advancement in terms of improvement of outcomes, quality of care and quality of life at lower healthcare cost for those undergoing stem cell transplantation.