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Feasibility of Outpatient Intensive Induction Chemotherapy for AML

By: Sarah Campen, PharmD
Posted: Thursday, May 21, 2020

Outpatient intensive induction chemotherapy appears to be a feasible treatment option for certain patients with newly diagnosed, relapsed, or refractory acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome, according to a pilot study presented in Blood Advances. During the study, 82.4% of outpatient induction patients received induction chemotherapy exclusively in the outpatient setting, and no patients died within 14 days of the initiation of induction chemotherapy.

“Effective implementation of an outpatient intensive induction chemotherapy program should include an anticipatory interprofessional team-based approach that includes nursing, social work, medical providers, and pharmacists,” stated Pamela S. Becker, MD, PhD, of the Fred Hutchinson Cancer Research Center, Seattle, and colleagues.

In this study, 17 patients with no significant organ dysfunction and a treatment-related mortality score corresponding to a day 28 mortality rate of up to 10% were treated as outpatients; 8 patients received initial induction chemotherapy, and 9 patients received salvage induction chemotherapy. Patients were evaluated daily by providers and admitted to the hospital only if complications arose.

During the course of chemotherapy administration, three patients were admitted: two for neutropenic fever and one for grade 3 mucositis. The remaining 14 patients completed induction chemotherapy administration in the outpatient setting.

Within the 30 days of starting induction but after completion of chemotherapy, 12 patients (70.6%) required hospital admission. Patients spent a median of 11 days in the hospital; reasons for admission included neutropenic fever, sepsis, altered mental status, mucositis, and chest pain. Two patients died within 60 days of initiating induction chemotherapy.

“Outpatient induction is safe and does not result in excessive utilization of blood products or other resources,” concluded Dr. Becker and colleagues.

Disclosure: For full disclosures of the study authors, visit ashpublications.org.



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