A recent study explored the benefits of outpatient induction therapy for people with acute myeloid leukemia (AML). Outpatient means that you do not need to stay at the hospital overnight for the treatment. Induction therapy is the first phase of treatment given to a person with AML.
Outpatient treatment has many benefits. It’s more convenient, helps you maintain your daily life, and it’s less expensive than inpatient care. But clinical trials need to be done to confirm if outpatient therapy is just as safe as inpatient care.
This study found that outpatient treatment may reduce the time between diagnosis and the start of treatment without increasing the risk of early death for people with AML.
What is AML, and how is it typically treated?
AML occurs when immature cells in the bone marrow grow out of control. The cells are called myeloblasts. They grow very fast and crowd out normal blood cells. This can lead to symptoms like fatigue, infections, and easy bruising or bleeding.
Typically, AML treatment includes intensive chemotherapy or targeted therapies based on a person’s specific disease features.
Why do you need to stay at the hospital during induction therapy for AML?
Induction therapy is the first phase of treatment given to a person with AML. It is one week of chemotherapy, followed by a recovery period. The goal of this treatment is to destroy as many cancer cells as possible and achieve remission.
Because AML is an aggressive cancer, induction therapy is intensive. The chemotherapy is given over ten days, but hospital stays can range from one week to six weeks. This is because the treatment weakens the immune system and lowers blood counts. You need close monitoring for complications, including infections, bleeding, and low blood cell counts.
Why is timely treatment important?
Starting treatment quickly is important for patients with AML because the disease can progress rapidly. However, some patients face delays due to limited hospital beds, financial challenges, and difficulty accessing specialized cancer care.
In some cases, patients may wait three to four weeks before starting chemotherapy. During this time, their health may worsen, and they may develop infections that make treatment more difficult. Sometimes patients also already have aggressive infections at the time of their diagnosis.
Researchers believe outpatient chemotherapy could help reduce these delays by allowing eligible patients to begin treatment without waiting for a hospital bed.
Study design
A small study in India recently tested if outpatient chemotherapy may be possible for people with AML. The study included 30 people with newly diagnosed AML or high-risk myelodysplastic syndrome (MDS). The patients were planned to receive 7+3 chemotherapy with cytarabine and daunorubicin. To be eligible for the study, the patients need to:
Be between the ages of 15 and 65
Have good overall health other than AML (performance status of 1 or 0 and normal organ function)
Meet baseline blood counts
Have no active infection
Have a caregiver
Be able to get to the hospital within an hour
Study participants received cytarabine for seven days and daunorubicin for three days. These chemotherapy medications are commonly used together to treat AML.
Patients either received outpatient treatment from the beginning or were discharged from the hospital early.
There was an intensive monitoring program to make sure patients received the care they needed. All participants also received counseling on:
Preventing and managing infection
Caring for their peripherally inserted central catheter (PICC), which is a tube inserted into a vein in the arm to deliver chemotherapy
Study results
The study found that 19 patients (65.5%) achieved complete remission. Complete remission means that tests show no signs of leukemia and blood counts have returned to normal levels.
Other key findings included:
65.5% achieved complete remission, meaning no signs of leukemia were found using standard tests.
3.3% (one patient) died within 28 days of starting chemotherapy.
93.3% developed febrile neutropenia, a condition involving fever and low levels of infection-fighting white blood cells.
20% developed bloodstream infections.
10% avoided hospitalization entirely during the first 28 days of treatment.
Patients started treatment within a median of 4.5 days after diagnosis.
Researchers also evaluated an additional 35 patients who received outpatient induction therapy. In this group, 5.7% died during the first 28 days of treatment.
What do these findings mean for patients?
This study highlights the importance of timely treatment for people with AML.
Outpatient chemotherapy could help some patients with AML begin treatment sooner while reducing the need for long hospital stays.
It’s important to note that outpatient treatment may not be appropriate for everyone. Patients in this study were carefully selected based on their overall health and ability to receive close medical monitoring.
The findings suggest that outpatient induction therapy may be a good option for certain patients with AML. Additional research is needed to better understand its safety and effectiveness.
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