Return to primary service among bone marrow transplant rehabilitation inpatients: An index for predicting outcomes.

e19509 Background: Inpatient rehabilitation bone marrow transplant patients can be challenging due to their medical fragility. Methods: One hundred forty-seven bone marrow transplant patients admitted to inpatient rehabilitation at a major national cancer hospital between January 1, 2002, and April 15, 2009, regardless of the patient’s primary cancer were retrospectively studied. Return to primary service and factors including age, gender, race, presence of graft-versus-host disease, type of hematopoietic stem cell transplant, type of primary cancer, white blood cell count upon rehabilitation admission, platelet count, albumin level, prealbumin level, creatinine level, and presence of antimicrobial agents were analyzed. Results: Forty-one percent (61/147) of bone marrow transplant patients were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 38% died after being transferred back to the primary service; 53%, 36%, and 39% of leukemia, lymphoma, and multiple myeloma transplant patients were transferred back to the primary service, respectively. No breast, germinoma, renal, testicular, or Waldenstrom macroglobulinemia patients were transferred back to primary service. Significant relationships were found with a platelet count < 43 (p<.01), a creatinine level > 0.9 (p<.05), the presence of an antibacterial agent (p<.05), the presence of an antifungal agent (p<.05) and leukemia, lymphoma or multiple myeloma type (p<.05). Using these 4 of these factors the Fu index was formulated to determine the likelihood of return to the primary team. Conclusions: Bone marrow transplant patients have a high rate of transfer from the inpatient rehabilitation unit back to the primary service and many of them eventually died while in the hospital. A low platelet count, a high creatinine level, the presence of an antibacterial agent, and the presence of an antifungal agent significantly increased the risk of return to primary. Close follow-up by the primary team while on the inpatient rehabilitation unit is recommended.