Feasibility of outpatient consolidation chemotherapy in older versus younger patients with acute myeloid leukemia

• Published in: American journal of hematology 2012-03, Vol.87 (3), p.323-326
• Main Authors: Saini, Lalit, Minden, Mark D., Schuh, Andre C., Yee, Karen W.L., Schimmer, Aaron D., Gupta, Vikas, Atenafu, Eshetu G., Murray, Cindy, Nixon, Shannon, Brandwein, Joseph M.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Care; Anti-Infective Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Consolidation Chemotherapy - adverse effects; Consolidation Chemotherapy - methods; Cytarabine - administration & dosage; Daunorubicin - administration & dosage; Etoposide - administration & dosage; Feasibility Studies; Female; Hematology; Humans; Infection - drug therapy; Infection - epidemiology; Infection - mortality; Leukemia, Myeloid - drug therapy; Leukemia, Myeloid - mortality; Male; Middle Aged; Mitoxantrone - administration & dosage; Neutropenia - chemically induced; Outpatients; Patient Readmission - statistics & numerical data
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.22268

Intensive consolidation chemotherapy for acute myeloid leukemia (AML) patients in complete remission is being increasingly administered on an outpatient basis. Although this approach has been found to be safe and feasible in younger patients, its safety in older patients remains unknown. We therefore undertook an evaluation of outpatient-based consolidation chemotherapy in older AML patients, and compared results to younger patients treated at the same institution over the same time period. The overall rate of readmission was ~50%, mostly for infections, with mean admission duration of 2 weeks. The overall mortality rate was 2.2%. Readmission rates and duration of readmission were somewhat higher in older patients, but infection rate, intensive care (ICU) admissions, and mortality rates were comparable to those in the younger patient cohort. However, we also observed that rates of febrile neutropenia, bacteremia, ICU admission, and death were significantly higher during the second consolidation, as compared with the first, in both younger and older patients. We conclude that outpatient-based consolidation therapy can be safely undertaken in a substantial proportion of fit older patients with AML.