Outpatient management of acute promyelocytic leukemia after consolidation chemotherapy

Leukemia. 1999 Apr;13(4):514-7. doi: 10.1038/sj.leu.2401375.

Abstract

The feasibility and safety of outpatient management of acute promyelocytic leukemia (APL) during the aplastic phase after intensive consolidation chemotherapy, the incidence and types of complications requiring readmission to hospital, and the number of hospital days spared by this policy have been prospectively evaluated. After chemotherapy administration, patients were evaluated on an ambulatory basis. In the event of any complication they referred to the Emergency Unit (EU) of our Department dedicated to outpatients with hematologic diseases. Forty patients with APL observed over a 4 year period were eligible for intensive chemotherapy. After the achievement of complete remission they received a total of 104 consolidation courses and in 98 instances they were followed on an ambulatory basis. There were 41 cases (42%) of rehospitalization for fever (40 cases) or severe anemia (one case). Only one patient died due to a brain hemorrhage. Streptococcus viridans was the organism most frequently isolated from blood. Empiric once-a-day antibacterial therapy with ceftriaxone and amikacin was effective in 87% of the cases and made possible early discharge in 28% of the cases to continue the antibiotic therapy on an outpatient setting. Patients were managed out of the hospital for 76% of the post-consolidation neutropenia period. Thanks to the availability of an EU specifically dedicated to outpatients with hematologic diseases, out-hospital management of APL patients after consolidation therapy appeared to be safe, well accepted, potentially cost-saving, and contributed to saving the risk of developing severe nosocomial infections.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care*
  • Amikacin / therapeutic use
  • Anemia / etiology
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / epidemiology
  • Bacterial Infections / etiology
  • Ceftriaxone / therapeutic use
  • Cerebral Hemorrhage / etiology
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology
  • Cross Infection / etiology
  • Cross Infection / microbiology
  • Drug Therapy, Combination / therapeutic use
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Fever / epidemiology
  • Fever / etiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Idarubicin / administration & dosage
  • Idarubicin / adverse effects
  • Incidence
  • Length of Stay / statistics & numerical data
  • Leukemia, Promyelocytic, Acute / complications
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Leukemia, Promyelocytic, Acute / mortality
  • Male
  • Middle Aged
  • Neutropenia / etiology
  • Remission Induction
  • Tretinoin / administration & dosage
  • Tretinoin / adverse effects

Substances

  • Tretinoin
  • Ceftriaxone
  • Amikacin
  • Idarubicin

Supplementary concepts

  • AIDA protocol