Introduction: Fit patients with acute myeloid leukaemia (AML) are treated with intensive therapy. This consists of an induction (intensive chemotherapy) and a consolidation (intensive chemotherapy and/or stem cell transplantation). Because of the risk of complications during these different cycles, patients are followed up in-hospital in most Belgian centres. However, the consolidation course is considered tolerable and could possibly be followed up on an outpatient basis, which may also have a financial and psychological benefit.
Objective: To identify patients for whom an outpatient approach is medically justified. To this end, prognostic factors predicting the development of neutropenic fever, intensive care unit (ICU) admission and chemotherapy-related mortality (day 30 mortality) were investigated.
Methods: Retrospective analysis of all patients aged sixteen years and older with a new diagnosis of AML who underwent at least one consolidation course at the Ghent University Hospital during the period February 2016 to November 2020.
Results: One hundred and fifty-five cycles of consolidation chemotherapy were listed in 83 patients. The average duration of hospitalisation was 22.4 days. At least one episode of neutropenic fever occurred in 52 courses (33.5%). The occurrence of neutropenic fever in the previous cycle of chemotherapy was significantly associated with a higher risk of developing neutropenic fever in the subsequent cycle (p = 0.04). In a multivariate analysis, this parameters were associated with neutropenic fever with an odds ratio of 1.9 (0.90–4.01) (p = 0.09). Given the rare occurrence of an ICU admission (n = 3) and early mortality (n = 1), it was not meaningful to perform statistical analysis on this.
Conclusion: Outpatient follow-up of a consolidation chemotherapy cycle for AML is feasible. Prospective follow-up research is needed to confirm this and to investigate the economical and psychological impact.
(BELG J HEMATOL 2023;14(3):139–44)