Outpatient management of acute myeloid leukemia after intensive consolidation chemotherapy is feasible and reduces hospital treatment costs.
BACKGROUND
This study assessed the feasibility and safety of out of hospital management of acute myeloid leukemia (AML) patients during consolidation therapy.


METHODS
103 consolidation cycles were analyzed retrospectively. All patients received treatment as inpatients; they were discharged provided they were in a good clinical condition and then either electively readmitted or managed as outpatients during the aplastic phase.


RESULTS
In 95/103 cycles (92%), discharge was feasible after a median of 7 (6-16) days. In 45 cycles, patients were electively readmitted at the onset of chemotherapy induced cytopenia after a median time of 12 (9-16) days. In 50 cycles, patients were managed as outpatients. In 23/50 outpatient cycles (46%), patients required rehospitalization, the main cause being neutropenic fever. There was 1 treatment related death due to sepsis in a patient in the outpatient group, accounting for an overall mortality of 2%. Transfusion requirements, occurrence of grade 3-4 toxicity, and disease free and overall survival after a median followup of 20 months did not differ between the treatment strategies. Comparison of diagnosis related group (DRG) proceeds revealed a 40% reduction with the outpatient strategy.


CONCLUSIONS
Outpatient management of consolidation therapy in selected AML patients appears to be feasible and safe and may reduce hospital treatment costs.
Department of Hematology, University Hospital Essen, Germany.
Lewin
L
Eisele
Florian
F
Günther
Peter
P
Ebeling
Jens
J
Nabring
Ulrich
U
Dührsen
Jan
J
Dürig
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000741:Anemia, Aplastic / Q000139:chemically induced*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001772:Blood Cell Count; D001803:Blood Transfusion; D003561:Cytarabine / Q000008:administration & dosage / Q000633:toxicity; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D009894:Opportunistic Infections / Q000139:chemically induced; D010351:Patient Discharge; D010359:Patient Readmission; D012189:Retrospective Studies; D055815:Young Adult
D003561:Cytarabine