Multidisciplinary nutritional support for autologous hematopoietic stem cell transplantation: a cost-benefit analysis.

OBJECTIVE: The objective of the present study was to evaluate the economic and clinical efficacy of a multidisciplinary nutritional support team (NST) for autologous stem cell transplantation. METHODS: We performed a retrospective cost-benefit analysis of autologous stem cell transplantation (ASCT) in patients with and without NST intervention at a single institute. Patients (n = 120) had undergone 169 ASCTs, 67 before the commencement of NST intervention in September 2005 and 102 after September 2005. The conditioning regimens, prophylactic antibiotics, and supportive care were unchanged from 2001 through 2008. The duration of hospitalization, cost, and laboratory data were analyzed. RESULTS: With NST intervention, the duration of total parenteral nutrition, absence of oral food intake, hospitalization, and therapeutic antibiotic usage were significantly shortened by 11.4, 9.7, 8.1, and 4.5 d, respectively. With NST intervention, the incidence of hepatic adverse events and hyperglycemia was low, and the total cost of hospitalization was significantly decreased by 403 600 yen (US $4484.40). Two cases of therapy-related death were recorded before September 2005. No therapy-related mortality was observed after commencement of NST intervention; however, the difference was not significant. CONCLUSION: Multidisciplinary NST intervention has a positive effect on cost decrease, and it may decrease the incidence of adverse events associated with ASCT and total parenteral nutrition.

[Long-term follow-up of patients undergoing allogeneic hematopoietic stem cell transplantation in Japan].

The number of hematopoietic stem cell transplantations and recipients with late complications from transplantation are both increasing; therefore, we investigated the status of the long-term follow-up system for hematopoietic stem cell transplantation survivors in Japan using a mail questionnaire; 100 of 194 institutions replied. The median examination time for each patient was 12.5 min. Five percent of institutions had an outpatient transplantation clinic, 1% had a manual for long-term follow-up after stem cell transplantation, and 11% used NIH criteria for the diagnosis of chronic GVHD. The lack of human resources, such as doctors, nurses, and other co-medical staff for transplant patients, was a structural problem. In addition, the development of guidelines for Japanese patients and staff education are also required in the clinical process. Thus, a long-term follow-up system, training of human resources, and appropriate reallocation of funds for medical services are required.