Feasibility of Outpatient Follow-Up After High-Dose Cytarabine Consolidation in Patients With Acute Myeloid Leukemia

Background High-dose cytarabine (HiDAC) consolidation is an essential component of post-remission therapy for acute myeloid leukemia (AML) and is usually delivered in inpatient settings due to anticipated cytopenias, infection risks, and transfusion needs. However, rising healthcare burdens have prompted interest in outpatient administration, but evidence remains limited, particularly in resource-constrained environments. This study aimed to evaluate the feasibility, safety, and clinical outcomes of outpatient follow-up after HiDAC consolidation compared with those of inpatient management. Methods This prospective observational study included 50 patients with AML aged 12-60 years who achieved complete remission following induction therapy and subsequently received high-dose cytarabine consolidation at Dhaka Medical College and Hospital from March 1, 2023, to February 29, 2024. Participants were allocated to outpatient (n=25) or inpatient (n=25) follow-up groups based on clinical assessment and physician discretion, including performance status, caregiver availability, and proximity to the hospital. Demographic characteristics, comorbidities, hematologic parameters, adverse events, infection patterns, and healthcare utilization, particularly duration of hospitalization, were compared between the groups. Statistical analyses were performed using independent t-tests and chi-square tests, with statistical significance set at p≤0.05. Results  Baseline characteristics were comparable across groups. All patients experienced expected cytopenias, with no significant differences in non-hematologic toxicities. Severe neutropenia (absolute neutrophil count (ANC) <0.5×10⁹/L) was less frequent in the outpatient group (7 (28%) vs. 17 (68%); p=0.005), and nadir ANC was significantly higher. Infection rates were low overall, with no infection-related mortality. Outpatient follow-up markedly reduced hospital stay duration (10.76 ± 0.78 vs. 17.2 ± 1.68 days, p<0.001) without increasing complications, readmissions, or documented infections. Patterns of culture-positive infections and hematologic recovery were comparable between settings. Conclusions Outpatient follow-up after HiDAC consolidation appears to be a feasible approach and may be safe in carefully selected AML patients based on performance status, caregiver support, and proximity to the hospital, with reduced hospitalization and no observed increase in short-term complications. With structured monitoring and standardized supportive care, outpatient management may help reduce healthcare burden. Larger multicenter studies with longer follow-up are required to validate long-term outcomes and refine patient selection.