Outpatient management of acute promyelocytic leukemia after consolidation chemotherapy

Abstract

The feasibility and safety of outpatient management of acute promyelocytic leukemia (APL) during the aplastic phase after intensive consolidation chemotherapy, the incidence and types of complications requiring readmission to hospital, and the number of hospital days spared by this policy have been prospectively evaluated. After chemotherapy administration, patients were evaluated on an ambulatory basis. In the event of any complication they referred to the Emergency Unit (EU) of our Department dedicated to outpatients with hematologic diseases. Forty patients with APL observed over a 4 year period were eligible for intensive chemotherapy. After the achievement of complete remission they received a total of 104 consolidation courses and in 98 instances they were followed on an ambulatory basis. There were 41 cases (42%) of rehospitalization for fever (40 cases) or severe anemia (one case). Only one patient died due to a brain hemorrhage. Streptococcus viridans was the organism most frequently isolated from blood. Empiric once-a-day antibacterial therapy with ceftriaxone and amikacin was effective in 87% of the cases and made possible early discharge in 28% of the cases to continue the antibiotic therapy on an outpatient setting. Patients were managed out of the hospital for 76% of the post-consolidation neutropenia period. Thanks to the availability of an EU specifically dedicated to outpatients with hematologic diseases, out-hospital management of APL patients after consolidation therapy appeared to be safe, well accepted, potentially cost-saving, and contributed to saving the risk of developing severe nosocomial infections.

Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study

“…Unlike consolidation chemotherapy, after which outpatient management is well accepted by physicians and patients and is cost saving, 13 only a few retrospective and prospective studies have investigated whether selected patients could be safely discharged after completion of induction chemotherapy for AML/MDS. [5][6][7][8][9][10] Like these previous reports, our data suggest that outpatient management of selected patients with AML/MDS following induction or salvage chemotherapy is feasible and safe.…”

Infectious complications in patients with acute promyelocytic leukaemia treated with the AIDA regimen

“…In the event of any kind of emergency occurring at home, a haematological emergency unit (HEU) dedicated to outpatients with haematological diseases was available at our institution. 14,15 In the event of fever or other signs of infection during neutropenia, blood cultures as well as cultures from any presumed site of infection were obtained, and a chest radiograph was performed . True septicaemia was defined as the isolation of a bacterial or fungal pathogen from a single blood culture for all microorganisms, but coagulase-negative staphylococci for which at least two positive blood cultures in the same day were required.…”

Positive impact of selective outpatient management of high-risk acute myelogenous leukemia on the incidence of septicemia

“…discussion Ambulatory management of neutropenic AML patients with curative intent chemotherapy is gradually increasing in acceptance. Investigations currently published differ in patient selection, treatment design, and methodology; however, the main objectives of these investigations are similar in nature and focus on the safety and feasibility of ambulatory care [4][5][6][7][8]. This retrospective study was designed to evaluate the incidence and microbial etiology of septicemia following the implementation of an ambulatory policy for AML patients.…”

“…Ambulatory care has regularly been described in solid tumours, high-dose chemotherapy followed by autologous hematopoietic stem-cell transplantation (HSCT) and more recently in the allogeneic nonmyeloablative HSCT setting, despite earlier studies of protective isolation indicating an infection preventative benefit [1][2][3]. A small number of studies have reported outpatient management of select patients with AML [4][5][6][7][8]. These investigations have documented the feasibility of outpatient management in high-risk neutropenic AML patients [9,10].…”