Safe and feasible outpatient treatment following induction and consolidation chemotherapy for patients with acute leukaemia

TY - JOUR

T1 - Safe and feasible outpatient treatment following induction and consolidation chemotherapy for patients with acute leukaemia

AU - Møller, Tom

AU - Nielsen, Ove Juul

AU - Welinder, Pernille

AU - Dünweber, Anne

AU - Hjerming, Maiken

AU - Moser, Claus

AU - Kjeldsen, Lars

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Traditionally, patients with acute leukaemia are admitted to hospital during chemotherapy-induced pancytopenia, although a few recent reports have reported the feasibility and safety of outpatient treatment. We have developed an outpatient treatment programme for patients with acute leukaemia incorporating comprehensive patient education for self-care management at home during pancytopenia and involvement of patients in care of their tunnelled central venous catheter (CVC). During neutropenia, patients are treated with prophylactic ciprofloxacine, amoxicillin/clavulanic acid and fluconazole. Herein, we report the results of outpatient treatment of 60 patients with acute leukaemia (54 with acute myeloid leukaemia) followed prospectively in the period from March 2004 to 2007. After induction chemotherapy, outpatient treatment was possible after 48 of 73 induction courses, with no readmission in 19 of these (40%). A total of 129 consolidation courses were administered with outpatient treatment following 116 of these, with no readmission in 69 (59%). The median number of days spent at home with neutrophils below 0.5 × 109/L was 8 d per course following induction and 12 d following consolidation chemotherapy. The predominant cause of readmission was neutropenic fever, in most instances of unknown origin. Coagulase-negative staphylococci and Enterococcus faecium were the most frequently identified bacteria in blood cultures, whereas only four positive blood cultures with multiresistant Escherichia coli were identified in the entire patient cohort, the latter exclusively observed in patients receiving antibiotic prophylaxis. The majority of the patients were able to take care of their CVC including change in dressing and heparin flushing. There were 12 CVC-related infections. There were no treatment-related deaths. We conclude that outpatient treatment of patients with acute leukaemia is feasible and safe.

AB - Traditionally, patients with acute leukaemia are admitted to hospital during chemotherapy-induced pancytopenia, although a few recent reports have reported the feasibility and safety of outpatient treatment. We have developed an outpatient treatment programme for patients with acute leukaemia incorporating comprehensive patient education for self-care management at home during pancytopenia and involvement of patients in care of their tunnelled central venous catheter (CVC). During neutropenia, patients are treated with prophylactic ciprofloxacine, amoxicillin/clavulanic acid and fluconazole. Herein, we report the results of outpatient treatment of 60 patients with acute leukaemia (54 with acute myeloid leukaemia) followed prospectively in the period from March 2004 to 2007. After induction chemotherapy, outpatient treatment was possible after 48 of 73 induction courses, with no readmission in 19 of these (40%). A total of 129 consolidation courses were administered with outpatient treatment following 116 of these, with no readmission in 69 (59%). The median number of days spent at home with neutrophils below 0.5 × 109/L was 8 d per course following induction and 12 d following consolidation chemotherapy. The predominant cause of readmission was neutropenic fever, in most instances of unknown origin. Coagulase-negative staphylococci and Enterococcus faecium were the most frequently identified bacteria in blood cultures, whereas only four positive blood cultures with multiresistant Escherichia coli were identified in the entire patient cohort, the latter exclusively observed in patients receiving antibiotic prophylaxis. The majority of the patients were able to take care of their CVC including change in dressing and heparin flushing. There were 12 CVC-related infections. There were no treatment-related deaths. We conclude that outpatient treatment of patients with acute leukaemia is feasible and safe.

KW - Acute Disease

KW - Adolescent

KW - Adult

KW - Aged

KW - Ambulatory Care

KW - Anti-Infective Agents

KW - Female

KW - Humans

KW - Leukemia

KW - Male

KW - Middle Aged

KW - Neutropenia

KW - Pancytopenia

KW - Prospective Studies

U2 - 10.1111/j.1600-0609.2009.01397.x

DO - 10.1111/j.1600-0609.2009.01397.x

M3 - Journal article

C2 - 20002732

SN - 0902-4441

VL - 84

SP - 316

EP - 322

JO - Scandinavian Journal of Haematology

JF - Scandinavian Journal of Haematology

IS - 4

ER -