Positive impact of selective outpatient management of high-risk acute myelogenous leukemia on the incidence of septicemia

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Abstract

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. © 2007 European Society for Medical Oncology.

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Halim, T. Y., Song, K. W., Barnett, M. J., Forrest, D. L., Hogge, D. E., Nantel, S. H., … Lavoie, J. C. (2007). Positive impact of selective outpatient management of high-risk acute myelogenous leukemia on the incidence of septicemia. Annals of Oncology, 18(7), 1246–1252. https://doi.org/10.1093/annonc/mdm112

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