Outpatient consolidation chemotherapy in pediatric acute myeloid leukemia: a retrospective analysis.

BACKGROUND: To assess the outcomes of outpatient high dose cytosine arabinoside consolidation cycles in pediatric acute myeloid leukemia (AML) patients in comparison to inpatient treatment.
METHODS: We retrospectively analyzed 90 cycles of AML consolidation given to 30 patients between July 2003 and July 2007.
RESULTS: Median age was 8 years (range 1.5-15) and 22/30 (73.3%) were males. Sixty-nine of 90 (76.7%) cycles were given on an ambulatory basis; readmission occurred in 25/69 (36.2%) and there was one death. The outpatient cycles in comparison to the inpatient cycles required significantly fewer invasive blood investigations (p<0.001) but had comparable number of blood products administered as supportive therapy. There was no significant difference in the frequency of granulocyte colony stimulating factor usage and recovery time of absolute neutrophil count and platelet count. The incidence of febrile neutropenia though was comparable in the groups (72.5% outpatient versus 76.2% inpatient), but the duration (p=0.003) and subsequent therapeutic antifungal usage (p=0.001) was significantly more in inpatient administered cycles. Second line antibiotics were needed in 16/50 (32%) outpatient episodes of febrile neutropenia in contrast to 10/16 (72.5%) episodes of febrile neutropenia in inpatient courses (p=0.030).
CONCLUSIONS: Outpatient AML consolidation therapy is safe and feasible in children. It appears to result in less frequent invasive blood studies; shorter duration of febrile neutropenia and consequently less antimicrobial and antifungal usage as compared to inpatient consolidation cycles. To our knowledge, this report is the first of its kind looking specifically at outpatient consolidation chemotherapy in AML.