A study presented at the 2019 ASH Annual Meeting showed that outpatient administration of high-dose cytarabine is feasible and safe in patients with acute myeloid leukemia (AML).
In this patient population, high-dose cytarabine consolidation is usually given in the inpatient setting over approximately six to seven days; however, researchers sought to determine the safety and feasibility of moving this treatment to the outpatient setting.
Researchers recruited 10 consecutive adult patients with AML from the National University Cancer Institute in Singapore between September 2018 and July 2019. All patients received daily high-dose cytarabine for six consecutive days, prophylactic steroid eyedrops, and an oral antiemetic for seven days.
The initiative included a nursing workflow to facilitate the transition of care, and patients and caregivers were provided educational information. Prior to implementation of outpatient high-dose cytarabine treatment, outpatient nursing staff were trained on administration, blood monitoring, and common toxicities.
Nine patients received at least one cycle of high-dose cytarabine in the outpatient setting, for a total of 16 cycles, all but one which were deemed “successful” by the authors.
Adverse events (AEs) observed during the six days of treatment were cytarabine-related fever (n=3), grade 1 cytarabine-related rash (n=2), grade 2 vomiting (n=2), and presumed sepsis that required admission (n=1).
There were no cerebellar toxicities observed during treatment, and all AEs were managed in the outpatient setting except for one case of fever and hypotension. No treatment-related deaths occurred.
Median time to neutrophil recovery was 25 days (range, 22-30 days), and median time to platelet count recovery was 32 days (range, 21-63 days). After a median follow-up of five months (range, 1.0-7.5 months), all patients remained in complete remission.
Median time of delay administration was 50 minutes (range, 0-120 minutes), and 42% of cycles had a delay of less than 30 minutes; delays were mainly due to delayed preparation by pharmacist (70%), nursing-related (15%), and doctor-related (15%).
“With an average length of stay of seven days for inpatient administration of high-dose cytarabine, we have saved 112 bed days from this 16 cycles of outpatient [treatment],” the authors noted. “This would translate into 54% cost saving compared [with] inpatient cost. Other intangible benefits would include reduced risk of hospital-acquired infection, as well as improved psychosocial well-being of patients and their caregivers.”
The study is limited by its small patient population.
NG CH, Chen X, Lee FG, et al. Feasibility of outpatient high dose cytarabine in patients with acute myeloid leukemia. Abstract 2152. Presented at the 2019 ASH Annual Meeting, December 7, 2019; Orlando, Florida.