Improved Outcome of Acute Leukemia Patients Followed up In out-Patient Setting After High Dose Ara-C (HDAC) Consolidation with Infection Prophylaxis Strategies

• Published in: Blood 2010-11, Vol.116 (21), p.4363-4363
• Main Authors: El-Emam, Omyma, Zaidi, Syed Ziauddin A., Albeirouti, Bassim, Al-Humaidi, Abdul-Aziz, Al-Shanqeeti, Ali
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V116.21.4363.4363

Abstract 4363 Outpatient care of patients with malignancies has become increasingly common and is driven by health care costs, increased demand for existing inpatient resources, improved supportive care and patient wishes to spend the least amount of time in the inpatient setting. High dose Ara-C/cytosine arabinoside (HIDAC) consolidation is frequently used for most acute leukemias. Typically HIDAC consists of 12 hourly IV administrations of 3 grams/m2 dose of Ara-C every other day for a total of 6 doses. One of the authors (AS) had earlier pioneered the idea of giving HIDAC and discharging the patients for out-patient follow up. Prince Sultan Hematology Oncology Centre (PSHOC), Riyadh adopted “post-HIDAC early discharge” policy in late 2006 and later found that it is safe and has resulted in huge hospital-days saving in comparison to our contemporary policy of keeping the patients in hospital till they recover counts after going through nadir. Lately we have also added G-CSF along with antimicrobial prophylaxis during neutropenia for preventing/reducing the period of febrile neutropenia (FN) after HIDAC chemotherapy. Here we present the results of our practice improvement strategy analysis to evaluate the effectiveness of these new measures. Sixty five patients receiving 96 cycles of HIDAC between October 2004 and March 2009 were divided in three groups: First cohort of 23 patients (group I) were discharged without any kind of prophylaxis after HIDAC (35 cycles); and 30 patients in later cohort (group II) received prophylactic ciprofloxacin, fluconazole and acyclovir once absolute neutrophil count (ANC) dropped to