Implementation of Hospital-Level Care at Home for Acute Leukemia | Nikesh Shah, MD | #EHA 2025

Hey, thanks for joining. I'm Nikesh Shah. I am a junior faculty at Tampa General Hospital Cancer Institute in Tampa, Florida. And, just wanted to talk a little bit today about some of the research presented here at the European Hematology Association meeting in Italy and really talking about in-home care for acute leukemia patients. How do we get patients out of the hospital sooner? Both from leukemia induction. And if there's any challenges down the road where they need to be admitted? How do we get them home sooner? How do we get them staying at home with great level care and safety?

And so really, this is you know, we've started a pilot study at Tampa General Hospital. Really trying to do just that, trying to get patients home. So typically, as many of you now as, you know, acute leukemia induction chemotherapy takes a long time. You know, patients are typically in the hospital starting their induction and on average are in the hospital for a month and going through a lot of ups and downs during that time. And really, they're in the hospital for a month because of high risk of infections, frequency of blood transfusion needs and for monitoring purposes. And we had the novel idea of how do we do this at home, but do it safely. Safety was a paramount of the paramount importance for us with this project and with this study that we have going on now.

So we started a prox a little less than a year ago, have enrolled 28 patients so far, and been able to get patients home much earlier than we would be otherwise. And so our acute leukemia patients starting induction, some patients with ALL were able to go home as soon as day four is spend a good amount of time of their induction at home, come back to the hospital for chemotherapy when needed, and then get back home and really be able to deliver high level, inpatient level care at home. And so we have a team of nurses, physician assistant or nurse practitioner or a physician that comes out to the house at least once a day. The nursing team comes twice a day. Patients have a biometric vitals monitoring device on their chest at all times, so they have 24/7 remote monitoring.

And so we have a team in the hospital that takes a look at their vitals and gets alerted if there's a fever, abnormal blood pressure, abnormal heart rate, oxygenation issues, and immediately calls the patient to check in on them, make sure they're doing okay. If there's concerns a team goes out to the house immediately checks on the patient. We have a workflow in place for kind of how to manage side effects and problems. If they come up and either keep the patient at home or bring them back if needed.

For example, neutropenic fever is very common during acute leukemia induction or workflow for this is getting a team out to the house, check their temperature, do the same workup that we would do if they were in the hospital. So full set of labs, blood cultures, start antibiotics, start IV fluids, and then depending on the level of severity, either keep the person at home with ongoing treatment and monitoring, or bringing them back to the hospital for inpatient care.

Thankfully, this has been a success so far with our 28 patients. We had about a 20% rate of needing to bring patients back to the hospital for unexpected reasons. Half of those were for neutropenic fever. Others were unfortunately progressing leukemia or oxygenation issues that were unrelated to their leukemia and related to infection. This is in line with other programs who have not delivered in-home care at this level.

To our knowledge, this is the first program published that's delivered inpatient level care in the house. There have been some other programs that have that have published some pilot study results of early discharge for patients with acute leukemias, but they weren't able to provide inpatient level care at home. They really relied on bringing the patient back to clinic for outpatient care as needed. And so, to our knowledge, this is the first study that's been able to do this successfully.

The newer kind of next steps in our program are obviously expanding our population of who we can do this for. We, very recently started being able to deliver blood transfusions in the house with our nursing team. And so the nursing team stays for the duration of the transfusion. But as you know, a lot of a lot of folks with acute leukemia induction are getting transfusions multiple times a day or every day. And historically, that would need to keep them in the hospital. We're now able to do that at home safely.

We're also expanding our radius. And so currently patients need to live 30 to 40 minutes from the hospital again for safety reasons. We want to be able to bring them back or have a team go out urgently if needed. We're now we've we've had two patients be able to stay in an approved hotel right near our hospital and have a team kind of go out to that hospital every day and keep them out of the hospital. But at a hotel in a more homelike environment with the same level of safety and support that they need.

And so we're very excited about this initiative. I think the number one challenge that people have with acute leukemia induction is being stuck in the hospital for so long, and so being able to deliver high level inpatient level care at home or in a hotel safely can not only improve the patient experience. We're showing it keeps safety the same. An improved psychosocial right, and improves kind of mental health. And it lets us take care of more people with acute leukemias who really need high level inpatient care.

And so more to come on this. We're hopeful to present, you know, updates and more data as we enroll this program with more patients down the road. And so hopefully was you'll see more to come on this as we continue to do that. Thank you for listening.