Outpatient supportive care for pediatric acute myeloid leukemia: a single institution's experience
Renee Potashner1, Mark E Weinblatt2, Chana L Glasser2
1Department of Pediatrics, NYU Langone Hospital - Long Island, Mineola, NY, USA.
Insights
Pediatric acute myeloid leukemia (AML) patients can safely receive outpatient supportive care after chemotherapy, reducing hospital stays. This approach managed neutropenia days effectively, showing promise for future guidelines.
Area of Science:
- Pediatric Oncology
- Hematology
- Infectious Diseases
Background:
- Infections are a major cause of morbidity and mortality in pediatric acute myeloid leukemia (AML) patients undergoing chemotherapy.
- Current Children's Oncology Group (COG) guidelines recommend prolonged hospitalization until absolute neutrophil count (ANC) recovery, but antibiotic prophylaxis and discharge practices lack standardization.
- Existing protocols often lead to extended hospital stays, impacting patient quality of life and healthcare resource utilization.
Purpose of the Study:
- To evaluate the feasibility and safety of an institutional model for outpatient supportive care management in pediatric AML patients following early hospital discharge after chemotherapy.
- To assess outcomes related to infections, antibiotic use, and neutropenia duration in children managed with an early discharge strategy.
Main Methods:
- A retrospective chart review was conducted for pediatric AML patients treated between 2010 and 2019.
- Data collected included length of hospitalization, antibiotic administration, infection occurrences, and duration of neutropenia.
- Patients were discharged post-chemotherapy if clinically stable, with readmission protocols for fever and negative cultures.
Main Results:
- Sixty chemotherapy cycles were administered to 17 pediatric AML patients.
- Patients were discharged early if clinically stable, remaining outpatient for a mean of 15.8 neutropenia days per cycle.
- 12 infections occurred in 11 patients, with no reported deaths attributed to infection during the study period.
Conclusions:
- Outpatient supportive care management following early discharge appears to be a feasible and safe approach for pediatric AML patients.
- This model demonstrates potential for reducing hospitalizations without compromising patient safety regarding infections.
- Further research is warranted to establish definitive guidelines for outpatient supportive care in this patient population.
Abstract:
Infections are responsible for most treatment-related morbidity and mortality in pediatric acute myeloid leukemia (AML). Children's Oncology Group (COG) recommends hospitalization following chemotherapy until early absolute neutrophil count (ANC) recovery. No standard guidelines exist for antibiotic prophylaxis and discharge practices vary. Our objective was to report our institution's experience with outpatient supportive care management following early discharge. A retrospective chart review of pediatric AML patients treated at our institution from 2010 to 2019 was conducted. Data was collected on length of hospitalization, antibiotics administered, infections, and neutropenia duration. Seventeen patients underwent 60 chemotherapy cycles. All were discharged after completion of chemotherapy if clinically stable. Patients were re-admitted for fever and discharged on empiric antibiotics if afebrile with negative cultures. Prophylactic antibiotics were administered in 55 cycles. There were 12 infections in 11 patients and no deaths due to infection. Patients remained outpatient for a mean of 15.8 neutropenia days per cycle. Outpatient supportive care for children with AML may be feasible and safe. Further studies are needed to establish outpatient supportive care guidelines.
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