Outpatient management of acute myeloid leukemia after intensive consolidation chemotherapy is feasible and reduces hospital treatment costs

Abstract

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.

Conclusion: Outpatient management of consolidation therapy in selected AML patients appears to be feasible and safe and may reduce hospital treatment costs.