Safety and feasibility of outpatient high-dose cytarabine and intermediate-dose cytarabine for consolidation therapy in acute myeloid leukemia

Abstract

Introduction The standard of care consolidation therapy for acute myeloid leukemia is high-dose cytarabine or intermediate-dose cytarabine, which are traditionally given inpatient. At Moffitt Cancer Center, we have moved the administration of high-dose cytarabine and intermediate-dose cytarabine to the outpatient setting through the inpatient/outpatient program. To facilitate outpatient administration, high-dose cytarabine and intermediate-dose cytarabine are given in a shorter interval of every 10 h instead of 12 h. The safety of a shorter duration interval of high-dose cytarabine and intermediate-dose cytarabine is unknown. This study aims to assess the safety and feasibility of administering high-dose cytarabine and intermediate-dose cytarabine consolidation therapy in the inpatient/outpatient setting. Methods This is a retrospective chart review to analyze acute myeloid leukemia patients treated with inpatient/outpatient high-dose cytarabine or intermediate-dose cytarabine consolidation therapy at Moffitt Cancer Center from January 1, 2015, through November 1, 2018. The primary objective was to determine the incidence of hospitalization during the inpatient/outpatient administration of high-dose cytarabine or intermediate-dose cytarabine. Results Two hundred fifty-three of 255 cycles of high-dose cytarabine/intermediate-dose cytarabine were delivered outpatient over the reviewed time period to 118 patients. No patients receiving outpatient high-dose cytarabine/intermediate-dose cytarabine consolidation required hospitalization during chemotherapy. Our incidence of hospitalization (24%) after chemotherapy is consistent with the reported literature. Through the inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine, 1265 inpatient days were saved with an approximate revenue of $3,135,176 generated in our study period. Conclusion Inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine is both safe and feasible. Moving high-dose cytarabine/intermediate-dose cytarabine administration to the outpatient setting resulted in significant additional revenue vs. inpatient administration.

Outpatient consolidation chemotherapy with intermediate dose cytarabine has similar survival and relapses rates in acute myeloid leukemia as compared to high dose cytarabine: A single center analysis

“…One of the biggest limitations of administrating outpatient cytarabine is ensuring accessibility to and funding for daily oncology clinics operating long enough to provide q12h cytarabine. Potential solutions to this include shortening the dosing interval to q10h from q12h 26 . Our institution has moved to outpatient administration of cytarabine consolidation on a q24h interval in attempt to reduce hospitalization days, prolonged clinic hours associated with q12h dosing, and improve patient quality of life.…”

“…Potential solutions to this include shortening the dosing interval to q10h from q12h. 26 Our institution has moved to outpatient administration of cytarabine consolidation on a q24h interval in attempt to reduce hospitalization days, prolonged clinic hours associated with q12h dosing, and improve patient quality of life. Although our study does not directly analyse cost benefits, its clinical results are in line with those of other studies that did.…”

The Development of Ambulatory Cancer Care in the UK: A Scoping Review of the Literature

“…Twelve publications were categorised as retrospective data studies that reported analyses of existing health service data; characteristics of which are detailed among the data papers in Table 3. Articles published between 2008 and 2021 with one outlier from 1982, they predominately focus on demonstrating the feasibility, safety, clinical outcomes and efciencies associated with the AC pathway within difering international settings [2,3,[30][31][32][33][34][35][37][38][39]. Patient-reported outcomes were not included as a part of these analyses.…”

“…Here, an additional 1443 adult cancer treatment episodes were successfully delivered via AC across the 6-year period (2005-2011), avoiding treatment delays, maximising treatment outcomes and freeing up hospital beds for acutely unwell patients [3]. Within other international literature, transitioning chemotherapy regimens that were traditionally given as an inpatient to an outpatient basis to manage increasing demand on inpatient beds was also described by Li and colleagues [30] as a key driver. Within non USA literature, avoiding delays in treatment due to limited bed capacity was described by Bakhshi, Singh, and Swaroop [2] as one of the drivers for piloting the ambulatory model to give consolidation chemotherapy to paediatric haematology patients in India.…”