Outpatient supportive care following chemotherapy for acute myeloblastic leukemia

Treatment of acute myeloid leukemia (AML) involves aggressive myelosuppress ive chemotherapy that is generally administered on an inpatient basis. In o ur centre, AML therapy has been initiated in hospital and followed by early outpatient supportive care according to guidelines established in 1996. We conducted a review of all patients presenting with AML in our centre betwe en January 1996 and July 1998 to evaluate the safety and feasibility of ear ly outpatient supportive care. Nineteen consecutive patients treated with i nduction chemotherapy were analyzed. Patients were treated with cytosine ar abinoside and an anthracycline as aggressive AML induction therapy with the intent for early discharge. Ten patients (53%) were discharged within 10 d ays of starting induction chemotherapy (median 4.5 days). Reasons for remai ning in hospital included sepsis, serious medical complications, and social and geographic factors. Patients discharged early had a median of 1.5 read missions (range 0-3), but had 30% fewer in-hospital days than inpatients (p =0.03), and 57% fewer days of in-hospital antibiotic therapy (p=0.01). Ther e were no significant differences in transfusion requirements or episodes o f febrile neutropenia between the two groups. Thirty-one cycles of consolid ation therapy were administered to the 18 patients who survived induction. Early discharge from hospital was achieved for 30 cycles (97%). Nine cycles of consolidation chemotherapy were delivered using outpatient intravenous infusion pumps (29%). This study supports the feasibility and safety of ear ly discharge and outpatient supportive care following chemotherapy for AML.