Abstract
BACKGROUND: Administration of intensive induction chemotherapy followed by consolidation with postremission high- or intermediate-dose cytarabine (H/IDAC) remains a standard therapeutic approach in fit patients with nonadverse risk acute myeloid leukemia (AML). Historically, H/IDAC has been administered in the inpatient (IP) rather than outpatient (OP) setting given infection risk, transfusion and supportive care needs, and logistical challenges of OP treatment. However, the financial toxicity associated with IP chemotherapy hospitalization as well as risk of nosocomial infections and improvements in antimicrobial prophylaxis have highlighted the potential role for OP H/IDAC administration. METHODS: Accordingly, an OP H/IDAC treatment program was developed at Memorial Sloan Kettering Cancer Center in 2014 using an ambulatory pump system. To investigate the benefits and risks of this approach compared with standard IP H/IDAC administration, a retrospective single-center cohort study was conducted of 198 adult patients with AML who received either IP (59) or OP (139) H/IDAC consolidation. RESULTS: In the OP-treated group, this approach safely reduced hospitalization days per cycle (median, 0.8 vs 7.5, p < .001) without leading to increased incidence of hospitalization for febrile neutropenia (incidence rate ratio, 1.07, p = .8) or higher rate of major treatment complications. Total cost per cycle was significantly lower for the OP-treated group (median, $14,244 compared to $36,688, p < .001). CONCLUSIONS: In the largest cohort study of adult AML patients receiving OP H/IDAC, OP treatment administration was feasible, led to decreased hospital days and cost savings, and did not impact relapse free or overall survival compared to IP administration.