title: Outpatient management following intensive induction or salvage chemotherapy for acute myeloid leukemia.
abstract: Adults with newly diagnosed or relapsed acute myeloid leukemia (AML) commonly receive intensive chemotherapy to achieve disease remission. In the United States and many other countries, it is standard practice that these patients remain hospitalized "preemptively" until blood count recovery, owing to the risk for overwhelming infections and bleeding during pancytopenia. This care policy requires hospitalization for an average of 3 to 4 weeks after completion of chemotherapy. However, highly effective oral prophylactic antimicrobials are now available, and transfusion support of outpatients has become routine in recent years. As a result, the care of patients with hematologic malignancies treated with intensive modalities is increasingly shifting from inpatient to outpatient settings. Benefits of this shift could include the reduced need for medical resources (eg, transfusions or intravenous antimicrobial therapy), improved quality of life (QOL), decreased rates of nosocomial infections, and lower costs. Increasing evidence indicates that select AML patients undergoing intensive remission induction or salvage chemotherapy can be discharged early after completion of chemotherapy and followed closely in a well-equipped outpatient facility in a safe and costeffective manner. Further demonstration that the current approach of preemptive hospitalization is medically unjustified, economically more burdensome, and adversely affects health-related QOL would very likely change the management of these patients throughout this country and elsewhere, resulting in the establishment of a new standard practice that improves cancer care.
authors: Assistant member in the clinical research division at the Fred Hutchinson Cancer Research Center, and an assistant professor in the department of medicine at the University of Washington School of Medicine in Seattle, Washington.
authors: Roland B
authors: RB
authors: Walter
authors: Clinical nurse specialist for the Seattle Cancer Care Alliance and the University of Washington Medical Center in Seattle, Washington.
authors: Lenise R
authors: LR
authors: Taylor
authors: Physician assistant at the Seattle Cancer Care Alliance and teaching associate at the University of Washington Medical Center in Seattle, Washington.
authors: Kelda M
authors: KM
authors: Gardner
authors: Director of research development at the Seattle Cancer Care Alliance and a staff scientist at the Fred Hutchinson Cancer Research Center in Seattle, Washington.
authors: Kathleen Shannon
authors: KS
authors: Dorcy
authors: Senior research fellow at the Fred Hutchinson Cancer Research Center in Seattle, Washington.
authors: Jennifer E
authors: JE
authors: Vaughn
authors: Member of the clinical research division at the Fred Hutchinson Cancer Research Center, and a professor in the department of medicine at the University of Washington School of Medicine in Seattle, Washington.
authors: Elihu H
authors: EH
authors: Estey
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000188:drug therapy*; D016879:Salvage Therapy / Q000379:methods*