gms | German Medical Science

54. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

07. bis 10.09.2009, Essen

Outpatient management of acute myeloid leukemia after intensive consolidation chemotherapy is feasible and reduces treatment costs

Meeting Abstract

  • Lewin Eisele - IMIBE, Uniklinikum Essen, Essen
  • Florian Günther - Klinik für Hämatologie, Uniklinikum Essen, Essen
  • Peter Ebeling - Innere Klinik (Tumorforschung), Uniklinikum Essen, Essen
  • Jens Nabring - Medizin Controlling, Uniklinikum Essen, Essen
  • Ulrich Dührsen - Klinik für Hämatologie, Uniklinikum Essen, Essen
  • Jan Dürig - Klinik für Hämatologie, Uniklinikum Essen, Essen

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 54. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds). Essen, 07.-10.09.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09gmds075

DOI: 10.3205/09gmds075, URN: urn:nbn:de:0183-09gmds0751

Veröffentlicht: 2. September 2009

© 2009 Eisele et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Acute myeloid leukemia (AML) is an aggressive disease which is rapidly fatal without specific therapy. Intensive consolidation chemotherapy is followed by profound bone marrow aplasia during which patients have been traditionally hospitalized until blood count recovery. We assessed the feasibility and safety of out-of hospital management of AML patients during their consolidation therapy.

Methods: We retrospectively analysed 103 cycles of age-adapted cytarabine consolidation therapy given to 41 AML patients between 08/03 and 05/08. All patients (median age 59 years, range 21 – 74) received their treatment as inpatients, were discharged provided they were in a good clinical condition, and then either readmitted at the onset of neutropenia until hematopoietic recovery or managed entirely as outpatients during the aplastic phase.

Results: In 95/103 cycles (92%) discharge was feasible after a median of 7 (6 – 16) days. In 45 cycles patients were electively readmitted at the onset of chemotherapy induced cytopenia after an average time of 12 (9 – 16) days. In 50 cycles patients were managed entirely on an outpatient basis during their aplastic phase. In 23/50 cycles (46%) patients developed neutropenic fever (18/50 cycles, 36%) or other complications (5/50 cycles, 10%) and required rehospitalisation whereas 27/50 cycles (54%) were entirely managed in the outpatient setting. There was one treatment-related death due to infectious complications in a patient in the outpatient group accounting for an overall mortality rate of 2%. Transfusion requirements did not differ between the readmission and outpatient strategy and there were no differences in disease-free and overall survival after a median follow-up of 20 months. Estimation of hospital treatment costs employing the Diagnosis Related Group system (DRG) revealed a 40% reduction with the outpatient strategy.

Conclusion: Outpatient post-consolidation management in selected AML patients appears to be feasible, safe and may help to reduce treatment costs.