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. 2025 Aug 15;131(16):e70024.
doi: 10.1002/cncr.70024.

Outpatient cytarabine consolidation in acute myeloid leukemia safely reduces hospitalization time and treatment costs

Hannah Burton  1 , Leora Boussi  2 , David Nemirovsky  3 , Andriy Derkach  3 , Jenna Ciervo  2 , Christopher Famulare  2 , Kuo-Kai Chin  2 , Yannis Valtis  2 , Meira Yisraeli Salman  2 , Kishan Patel  2 , Gunjan L Shah  4 , Aaron D Goldberg  2 , Mark B Geyer  2   4 , Meghan C Thompson  2 , Martin S Tallman  2 , Eytan M Stein  2 , Sheng F Cai  2
Affiliations

Outpatient cytarabine consolidation in acute myeloid leukemia safely reduces hospitalization time and treatment costs

Hannah Burton et al. Cancer. .

Abstract

Background: Administration of intensive induction chemotherapy followed by consolidation with postremission high- or intermediate-dose cytarabine (H/IDAC) remains a standard therapeutic approach in fit patients with nonadverse risk acute myeloid leukemia (AML). Historically, H/IDAC has been administered in the inpatient (IP) rather than outpatient (OP) setting given infection risk, transfusion and supportive care needs, and logistical challenges of OP treatment. However, the financial toxicity associated with IP chemotherapy hospitalization as well as risk of nosocomial infections and improvements in antimicrobial prophylaxis have highlighted the potential role for OP H/IDAC administration.

Methods: Accordingly, an OP H/IDAC treatment program was developed at Memorial Sloan Kettering Cancer Center in 2014 using an ambulatory pump system. To investigate the benefits and risks of this approach compared with standard IP H/IDAC administration, a retrospective single-center cohort study was conducted of 198 adult patients with AML who received either IP (59) or OP (139) H/IDAC consolidation.

Results: In the OP-treated group, this approach safely reduced hospitalization days per cycle (median, 0.8 vs 7.5, p < .001) without leading to increased incidence of hospitalization for febrile neutropenia (incidence rate ratio, 1.07, p = .8) or higher rate of major treatment complications. Total cost per cycle was significantly lower for the OP-treated group (median, $14,244 compared to $36,688, p < .001).

Conclusions: In the largest cohort study of adult AML patients receiving OP H/IDAC, OP treatment administration was feasible, led to decreased hospital days and cost savings, and did not impact relapse free or overall survival compared to IP administration.

Keywords: acute myeloid leukemia; cytarabine consolidation; outpatient chemotherapy.

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Conflict of interest statement

Jenna Ciervo reports consulting for Blueprint Medicines, advisory board for Eli Lilly and Syndax, and speaker for HOPA. Yannis Valtis report a one‐time consultancy fee from EastRx. Gunjan L. Shah reports research funding to the institution from Janssen, Amgen, BMS, Beyond Spring, GPCR, and Recordati; data safety and monitoring board for ArcellX. Aaron D. Goldberg reports serving on a consultancy and advisory board for AbbVie, Astellas, BMS, Daiichi Sankyo, Genentech, Molecular Partners, and Syndax Pharmaceuticals; research funding from AbbVie, Aprea, Aptose, AROG, Cellularity, Kura Oncology, and Pfizer; honoraria from DAVA Oncology and Kura Oncology. Mark B. Geyer reports current research support from Amgen, Actinium Pharmaceuticals, and Tigen Pharma; past advisory and/or research support from Takeda, Jazz Pharmaceuticals, and Sanofi. Meghan C. Thompson reports research funding (paid to the institution) from AbbVie, Adaptive Biotechnologies, AstraZeneca, BeiGene, GenMab, Nurix Therapeutics, and Genentech; honoraria from Peerview Medical Institute, Clinical Care Options, Dava Oncology, Mashup Media, Philips Group Oncology Communications, Ultimate Opinions in Oncology, eScientiq, and MJH Life Sciences; advisory board/consulting for AbbVie, AstraZeneca, BeiGene, Janssen, Loxo Oncology at Lilly; travel support from Dava Oncology, Nurix Therapeutics, and Genmab. Martin S. Tallman reports serving on an advisory board for Moleculin, SDK Therapeutics, Foghorn Therapeutics, and HOVON (H0159); royalties from UpToDate. Eytan M. Stein reports consultancy for Abbvie, Agios, Astellas, AstraZeneca, Boehringer Ingelheim, Celgene, Daiichi‐Sannkyo, Genentech, Gilead, Jazz, Johnson & Johnson, Kura, Servier, Sobi, Intellisphere LLC, and Syndax. Sheng F. Cai reports serving as a consultant and/or being a shareholder for Daiichi‐Sankyo and Ursamin, none of which is directly related to the content of this paper; research support from Syndax, Trio, and Actinium; inventor on a patent related to menin inhibition WO/2017/132398A1. The remaining authors declare no relevant competing financial interests.

Figures

FIGURE 1
FIGURE 1
Hospitalization days per cycle for IP vs OP H/IDAC. The median number of hospitalization days per cycle, including chemotherapy and non‐chemotherapy admissions, was 7.5 days for the IP group and 0.8 days for the OP group (p < .001). H/IDAC indicates high‐ or intermediate‐dose cytarabine; IP, inpatient; OP, outpatient.
FIGURE 2
FIGURE 2
Febrile neutropenia hospitalizations per cycle for IP vs OP H/IDAC. There was no significant difference in febrile neutropenia hospitalizations in the IP and OP groups before and after adjusting for age, gender, ECOG performance status, and disease type and risk category (IRR 1.07, p = .8; IRR 0.8, p = .5). ECOG indicates Eastern Cooperative Oncology Group; H/IDAC, high‐ or intermediate‐dose cytarabine; IP, inpatient; IRR, incidence relative risk; OP, outpatient.
FIGURE 3
FIGURE 3
Relapse‐free and overall survival for IP versus OP groups. There was no significant difference in (A) 2‐year RFS (69 vs 67%, p = .8) or (B) 2‐year OS (76 vs 80%, p = .7) following start of IP vs OP H/IDAC after adjusting for age and ELN risk category. ELN indicates European LeukemiaNet; H/IDAC, high‐ or intermediate‐dose cytarabine; IP, inpatient; OP, outpatient; RFS, relapse‐free survival.
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