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Discharge planning begins at the earliest time of engraftment, which is typically defined as the point at which an absolute neutrophil count (ANC) greater than or equal to 500/mm3 has been achieved.
To be discharged from the Transplant Unit a patient must have no fever, be able to receive intravenous and oral medications as an outpatient, have no pain or have pain that is well controlled, and have no significant infectious or treatment-related complications. A clinical nurse specialist, clinical dietitian, and clinical pharmacist will meet with the family to assess the patient’s discharge needs and to educate the patient and family about the procedures necessary for the patient’s outpatient care.
Once a patient is able to return home after their initial stem cell transplant, the attending physician will send a letter summarizing the patient’s course to the referring physician. Recipients of autologous stem cell transplants will return only for protocol-required tests; the referring physicians are expected to provide routine tests and clinical care.
During the first year, patients who have received an allogeneic stem cell transplant will return monthly to our institution. During the second year, these patients are seen every two to three months at St. Jude; during the third year, patients are seen approximately every four months; during the fourth year, every six months. After that point, these patients are seen once a year until they are 18 years old or until 10 years after the transplant has passed, whichever is longer. At that time, patients are discharged permanently from the hospital and given a summary of their entire treatment.