Feasibility of outpatient consolidation chemotherapy in older versus younger patients with acute myeloid leukemia

Saini, Lalit; Minden, Mark D.; Schuh, Andre C.; Yee, Karen; Schimmer, Aaron D.; Gupta, Vikas; Atenafu, Eshetu G.; Murray, Cindy; Nixon, Shannon; Brandwein, Joseph

doi:10.1002/ajh.22268

Cited by 17 publications

(18 citation statements)

References 32 publications

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“…The characteristics of the patients receiving ambulatory-based consolidation chemotherapy have been previously described [11], and are summarized in Table 1. There was no significant difference in the median age of patients between C1 and C2; 54.6% of patients in C1 and 52.3% in C2 were male and the proportion of patients age ≥ 60 was 30% in C1 and 33% in C2 (p=NS).…”

Section: Resultsmentioning

confidence: 99%

“…Eligibility requirements were as previously described [11]. Patients received the second consolidation cycle following peripheral count recovery from the first cycle and resolution of any previous bacterial infections.…”

Section: Methodsmentioning

confidence: 99%

“…Ambulatory chemotherapy, subsequent monitoring and supportive care were provided as previously described [11] either in the ambulatory care area of the PMH or a local community hospital/clinic. Patients under age 60 (younger cohort) received two cycles of consolidation therapy (C1 and C2), each consisting of high dose cytarabine (HiDAC) 3 grams/m 2 IV q12 hours × 6 doses on days 1, 3, and 5, plus daunorubicn 45 mg/m 2 IV daily on days 1 and 2.…”

Section: Methodsmentioning

confidence: 99%

“…However, there are limited data on the characteristics of infectious complications in this setting. We have previously shown that infectious complications increase in the second cycle of ambulatory AML consolidation therapy resulting in greater need for intensive care unit (ICU) support and increased mortality [11]. As these findings may relate to breakthrough infections caused by the development of antibiotic resistant microbes despite prophylactic antibiotic use, we conducted a retrospective analysis evaluating the spectrum of microbiological isolates and their antibiotic resistance patterns in AML patients undergoing ambulatory-based consolidation chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Ambulatory consolidation chemotherapy for acute myeloid leukemia with antibacterial prophylaxis is associated with frequent bacteremia and the emergence of fluoroquinolone resistant E. Coli

et al. 2013

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BackgroundAmbulatory consolidation chemotherapy for acute myeloid leukemia (AML) is frequently associated with bloodstream infections but the spectrum of bacterial pathogens in this setting has not been well-described.MethodsWe evaluated the emergence of bacteremias and their respective antibiotic susceptibility patterns in AML patients receiving ambulatory-based consolidation therapy. Following achievement of complete remission, 207 patients received the first cycle (C1), and 195 the second cycle (C2), of consolidation on an ambulatory basis. Antimicrobial prophylaxis consisted of ciprofloxacin, amoxicillin and fluconazole.ResultsThere were significantly more positive blood cultures for E. coli in C2 as compared to C1 (10 vs. 1, p=0.0045); all E. coli strains for which susceptibility testing was performed demonstrated resistance to ciprofloxacin. In patients under age 60 there was a significantly higher rate of Streptococccus spp. bacteremia in C2 vs. C1; despite amoxicillin prophylaxis all Streptococcus isolates in C2 were sensitive to penicillin. Patients with Staphylococcus bacteremia in C1 had significantly higher rates of Staphylococcus bacteremia in C2 (p=0.009, OR=8.6).ConclusionsFor AML patients undergoing outpatient-based intensive consolidation chemotherapy with antibiotic prophylaxis, the second cycle is associated with higher rates of ciprofloxacin resistant E. coli, penicillin-sensitive Streptococcus bacteremias and recurrent Staphylococcus infections.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ambulatory consolidation chemotherapy for acute myeloid leukemia with antibacterial prophylaxis is associated with frequent bacteremia and the emergence of fluoroquinolone resistant E. Coli

et al. 2013

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“…Many large academic institutions are currently managing a significant portion of their AML patients in the outpatient setting during post-remission therapy, an approach that has been found to be safe and feasible in pediatric patients as well as younger and older adults [12–15,49–51]. If encouraging results in the literature are to support an overall change in practice for patients following (re-)induction therapy, however, potential barriers to implementation at smaller academic and community practice hospitals need to be recognized and addressed.…”

Section: Barriers To Implementation Of Outpatient Managementmentioning

confidence: 99%

Outpatient care of patients with acute myeloid leukemia: Benefits, barriers, and future considerations

2016

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Patients with acute myeloid leukemia (AML) who receive intensive induction or re-induction chemotherapy with curative intent typically experience prolonged cytopenias upon completion of treatment. Due to concerns regarding infection and bleeding risk as well as significant transfusion and supportive care requirements, patients have historically remained in the hospital until blood count recovery—a period of approximately 30 days. The rising cost of AML care has prompted physicians to reconsider this practice, and a number of small studies have suggested the safety and feasibility of providing outpatient supportive care to patients following intensive AML (re-) induction therapy. Potential benefits include a significant reduction of healthcare costs, improvement in quality of life, and decreased risk of hospital-acquired infections. In this article, we will review the currently available literature regarding this practice and discuss questions to be addressed in future studies. In addition, we will consider some of the barriers that must be overcome by institutions interested in implementing an “early discharge” policy. While outpatient management of selected AML patients appears safe, careful planning is required in order to provide the necessary support, education and rapid management of serious complications that occur among this very vulnerable patient population.

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Finding new bearings: a qualitative study on the transition from inpatient to ambulatory care of patients with acute myeloid leukemia

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Rodin

Schimmer

et al. 2014

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Feasibility of outpatient consolidation chemotherapy in older versus younger patients with acute myeloid leukemia

Cited by 17 publications

References 32 publications

Ambulatory consolidation chemotherapy for acute myeloid leukemia with antibacterial prophylaxis is associated with frequent bacteremia and the emergence of fluoroquinolone resistant E. Coli

Ambulatory consolidation chemotherapy for acute myeloid leukemia with antibacterial prophylaxis is associated with frequent bacteremia and the emergence of fluoroquinolone resistant E. Coli

Outpatient care of patients with acute myeloid leukemia: Benefits, barriers, and future considerations

Finding new bearings: a qualitative study on the transition from inpatient to ambulatory care of patients with acute myeloid leukemia

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