Safe and feasible outpatient treatment following induction and consolidation chemotherapy for patients with acute leukaemia
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Safe and feasible outpatient treatment following induction and consolidation chemotherapy for patients with acute leukaemia. / Møller, Tom; Nielsen, Ove Juul; Welinder, Pernille; Dünweber, Anne; Hjerming, Maiken; Moser, Claus; Kjeldsen, Lars.
In: European Journal of Haematology. Supplementum, Vol. 84, No. 4, 01.04.2010, p. 316-22.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Safe and feasible outpatient treatment following induction and consolidation chemotherapy for patients with acute leukaemia
AU - Møller, Tom
AU - Nielsen, Ove Juul
AU - Welinder, Pernille
AU - Dünweber, Anne
AU - Hjerming, Maiken
AU - Moser, Claus
AU - Kjeldsen, Lars
PY - 2010/4/1
Y1 - 2010/4/1
N2 - Traditionally, patients with acute leukaemia are admitted to hospital during chemotherapy-induced pancytopenia, although a few recent reports have reported the feasibility and safety of outpatient treatment. We have developed an outpatient treatment programme for patients with acute leukaemia incorporating comprehensive patient education for self-care management at home during pancytopenia and involvement of patients in care of their tunnelled central venous catheter (CVC). During neutropenia, patients are treated with prophylactic ciprofloxacine, amoxicillin/clavulanic acid and fluconazole. Herein, we report the results of outpatient treatment of 60 patients with acute leukaemia (54 with acute myeloid leukaemia) followed prospectively in the period from March 2004 to 2007. After induction chemotherapy, outpatient treatment was possible after 48 of 73 induction courses, with no readmission in 19 of these (40%). A total of 129 consolidation courses were administered with outpatient treatment following 116 of these, with no readmission in 69 (59%). The median number of days spent at home with neutrophils below 0.5 x 10(9)/L was 8 d per course following induction and 12 d following consolidation chemotherapy. The predominant cause of readmission was neutropenic fever, in most instances of unknown origin. Coagulase-negative staphylococci and Enterococcus faecium were the most frequently identified bacteria in blood cultures, whereas only four positive blood cultures with multiresistant Escherichia coli were identified in the entire patient cohort, the latter exclusively observed in patients receiving antibiotic prophylaxis. The majority of the patients were able to take care of their CVC including change in dressing and heparin flushing. There were 12 CVC-related infections. There were no treatment-related deaths. We conclude that outpatient treatment of patients with acute leukaemia is feasible and safe.
AB - Traditionally, patients with acute leukaemia are admitted to hospital during chemotherapy-induced pancytopenia, although a few recent reports have reported the feasibility and safety of outpatient treatment. We have developed an outpatient treatment programme for patients with acute leukaemia incorporating comprehensive patient education for self-care management at home during pancytopenia and involvement of patients in care of their tunnelled central venous catheter (CVC). During neutropenia, patients are treated with prophylactic ciprofloxacine, amoxicillin/clavulanic acid and fluconazole. Herein, we report the results of outpatient treatment of 60 patients with acute leukaemia (54 with acute myeloid leukaemia) followed prospectively in the period from March 2004 to 2007. After induction chemotherapy, outpatient treatment was possible after 48 of 73 induction courses, with no readmission in 19 of these (40%). A total of 129 consolidation courses were administered with outpatient treatment following 116 of these, with no readmission in 69 (59%). The median number of days spent at home with neutrophils below 0.5 x 10(9)/L was 8 d per course following induction and 12 d following consolidation chemotherapy. The predominant cause of readmission was neutropenic fever, in most instances of unknown origin. Coagulase-negative staphylococci and Enterococcus faecium were the most frequently identified bacteria in blood cultures, whereas only four positive blood cultures with multiresistant Escherichia coli were identified in the entire patient cohort, the latter exclusively observed in patients receiving antibiotic prophylaxis. The majority of the patients were able to take care of their CVC including change in dressing and heparin flushing. There were 12 CVC-related infections. There were no treatment-related deaths. We conclude that outpatient treatment of patients with acute leukaemia is feasible and safe.
KW - Acute Disease
KW - Adolescent
KW - Adult
KW - Aged
KW - Ambulatory Care
KW - Anti-Infective Agents
KW - Female
KW - Humans
KW - Leukemia
KW - Male
KW - Middle Aged
KW - Neutropenia
KW - Pancytopenia
KW - Prospective Studies
U2 - 10.1111/j.1600-0609.2009.01397.x
DO - 10.1111/j.1600-0609.2009.01397.x
M3 - Journal article
C2 - 20002732
VL - 84
SP - 316
EP - 322
JO - Scandinavian Journal of Haematology
JF - Scandinavian Journal of Haematology
SN - 0902-4441
IS - 4
ER -
ID: 34251596