Annals of Oncology Advance Access originally published online on April 17, 2007
Annals of Oncology 2007 18(7):1246-1252; doi:10.1093/annonc/mdm112
© 2007 European Society for Medical Oncology
supportive care |
Positive impact of selective outpatient management of high-risk acute myelogenous leukemia on the incidence of septicemia
1 Department of Immunology and Microbiology, University of British Columbia, Vancouver
2 The Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Vancouver Hospital Health Sciences Centre, BC Cancer Agency, University of British Columbia, Vancouver, Canada
* Correspondence to: Dr J. C. Lavoie, Vancouver General Hospital, Division of Hematology, Room 10149, 10th floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada. Tel: +1 604-875-4863; Fax: +1 604-875-4763; E-mail: jlavoie{at}bccancer.bc.ca
Background: Curative intent chemotherapy for acute myelogenous leukemia (AML) leads to prolonged severe neutropenia, during which patients are highly susceptible to infection. Traditionally these high-risk patients were treated as inpatients. Our center recently implemented a selective ambulatory management policy for AML patients undergoing chemotherapy.
Materials and methods: A retrospective analysis was conducted to assess the occurrence of septicemia in AML patients treated over a 5 years period with curative intent chemotherapy. This review encompasses a change in policy from primarily inpatient care to selective outpatient management coupled with prophylactic antibiotic therapy.
Results: A total of 294 patients, receiving 623 cycles of chemotherapy were identified. A significant decrease in septicemia was observed from the inpatient to outpatient cohort (22% to 13% P < 0.05), which correlated with the shift towards outpatient treatment of consolidation cycles. A shift from Gram-negative to Gram-positive organisms as the cause of septicemia was also detected in the outpatient cohort, likely due to the introduction of ciprofloxacin prophylaxis. No significant emerging resistance and no septicemia-related mortality were noted in the outpatient cohort.
Conclusion: The observed decrease in the incidence of septicemia in the ambulatory cohort adds supportive evidence to the feasibility of selective outpatient management of AML patients with respect to infectious complications.
Key words: acute myelogenous leukemia, ambulatory, neutropenia, outpatient, prophylaxis, septicemia
Received for publication September 7, 2006. Revision received January 19, 2007. Accepted for publication February 26, 2007.