Shifting to outpatient management of acute myeloid leukemia: a prospective experience.
BACKGROUND
We assessed the feasibility of outpatient chemotherapy and supportive care in patients with acute myeloid leukemia (AML).


METHODS
All patients receiving curative intent chemotherapy between 09/01 and 10/02 and meeting our criteria received supportive care post induction chemotherapy as well as their entire consolidation chemotherapy cycles as outpatients. Patients received antimicrobial prophylaxis; those developing episodes of fever and not meeting the criteria for admission were treated with outpatient intravenous antibiotics.


RESULTS
Seventy-one cycles of induction chemotherapy were administered for newly diagnosed or relapsed AML. In 25 cycles the patient was discharged post chemotherapy prior to count recovery. Of these, 14 patients developed one or more febrile episodes as an outpatient and nine (36%) required readmission to hospital. Sixty-seven consolidation cycles were given on an outpatient basis. In 39 cycles there was one or more febrile episodes and in 14 (21%) admission was required. Infections were documented in four cases during induction and in 27 during consolidation. There were no treatment-related deaths.


CONCLUSIONS
Outpatient management of AML is safe and feasible using the strategies outlined in this report.
Savoie
M L
ML
The Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Vancouver Hospital Health Sciences Centre, BC Cancer Agency and the University of British Columbia, Vancouver, Canada. lynn.savoie@calgaryhealthregion.ca
Nevil
T J
TJ
Song
K W
KW
Forrest
D L
DL
Hogge
D E
DE
Nantel
S H
SH
Shepherd
J D
JD
Smith
C A
CA
Sutherland
H J
HJ
Toze
C L
CL
Lavoie
J C
JC
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007297:Inpatients; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D003630:Daunorubicin