No significant differences were observed in rates of bacteremia with inpatient (IP) vs outpatient (OP) management of children with newly diagnosed acute myeloid leukemia (AML) who are considered “early discharge eligible” following intensive chemotherapy. The findings of this study were presented at the 61st Annual Society of Hematology (ASH) Meeting & Exposition, held in Orlando, Florida.

Prolonged periods of neutropenia typically follow intensive chemotherapy induction and intensification courses administered to patients with AML. Although the majority of US cancer centers follow current supportive care recommendations for hospitalization of patients with AML treated with intensive chemotherapy courses until after resolution of neutropenia, data in support of these recommendations are scarce.

The aims of this study were 3-fold:

  • To retrospectively compare the rates of bacteremia and times to next treatment course for patients with AML aged younger than 19 years classified as “early discharge eligible” who received IP vs OP management following administration of intensive chemotherapy;
  • To conduct interviews with patients and families regarding their experiences with IP or OP management; and
  • To evaluate health-related quality of life (HRQOL), using parent proxy Peds QoL scores assessed prior to the start of, and after neutrophil recovery, for one course of chemotherapy for those managed in the IP vs OP setting.

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Regarding the first study aim, data were collected from 17 US-based centers for 573 children undergoing initial treatment for AML between 2011 and 2019 who were classified as “early discharge eligible,” which included those not receiving supplemental oxygen, vasoactive infusion, or dialysis and without documented fever or bacteremia within 3 days prior to the end of the chemotherapy course.


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The overall group included 276 patients who had completed induction I, 490 who completed induction II, 371 who completed intensification I, 284 who completed intensification II, and 43 who completed intensification III courses, with the percentages of patients treated in the OP setting ranging from 8.7% to 28.0%, depending on the chemotherapy course. Mean patient age was 9 years, and 65%, 4%, and 31% of patients had disease classified as low-, intermediate-, and high-risk, respectively.

A key study finding was no significant differences in the rates of bacteremia for patients managed in an OP vs an IP setting following induction II (19.3% vs 21.5%), intensification I (26.0% vs 28.5%), and intensification II (32.1% vs 46.1%) courses, and in all courses overall (23.8% vs 29.0%). (No analysis was performed after induction I because only 8.7% of patient management was conducted in an OP setting.) In addition, the number of days to next course were similar in these 2 groups (30.3 in OP setting vs 31.6 in IP setting; P =.17).

Semistructured interviews conducted with patients/family members at 9 centers did not reveal differences in rates of satisfaction with management setting, with 85% and 86% of patients’ families expressing satisfaction with treatment in the IP and OP settings, respectively. In addition, parent proxy Peds QOL scores did not differ with management setting.

Although the study authors concluded that OP management during neutropenia may be appropriate for some children with AML following intensive chemotherapy, they cautioned that “implementation studies are needed to identify patient/family characteristics that portend a positive experience with an OP strategy.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Getz KD, Li Y, Szymczak JE, et al. Home or away from home: a multi-institution study comparing medical outcomes, patient perspectives, and health-related quality of life for outpatient versus inpatient management after chemotherapy for pediatric acute myeloid leukemia. Oral presentation at: 61st ASH Annual Meeting & Exposition; December 7-10, 2019; Orlando, FL. Abstract 379.

This article originally appeared on Oncology Nurse Advisor