Review Article Open Access
Volume 2 | Issue 3 | DOI: https://doi.org/10.33696/haematology.2.033

Moving the Treatment of Acute Myeloid Leukemia to the Outpatient Setting: Current Expert Perspectives and Consensus Findings

  • 1Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
  • 2University of Colorado, Aurora, Colorado, USA
  • 3The University of Arizona Cancer Center, Tucson, AZ, USA
  • 4Barnes-Jewish Hospital, St. Louis, MO, USA
  • 5Moffitt Medical Group at Tampa General Hospital, Tampa, FL, USA
  • 6Duke University School of Medicine, Durham, NC, USA
+ Affiliations - Affiliations

Corresponding Author

Chetasi Talati, Chetasi.Talati@moffitt.org

Received Date: May 08, 2021

Accepted Date: June 11, 2021


Intensive treatments for acute myeloid leukemia (AML) have traditionally been administered on an inpatient basis due in part to chemotherapy regimen infusion requirements, transfusion support, and the need for close monitoring for infectious complications and adverse events. However, hospitalization is a major component of burgeoning healthcare costs and may contribute to impaired quality of life in patients with AML. To help inform the ongoing discussion regarding the merits and challenges of outpatient administration of AML therapy, a multidisciplinary panel of experts were engaged to identify areas of consensus, explore ongoing uncertainties, and develop an algorithm that may help inform discussions on outpatient treatment between healthcare providers and patients. Based on available evidence and clinical experience, inpatient treatment remains appropriate for majority of patients with AML undergoing conventional intensive induction chemotherapy. The more recently introduced liposomal formulation of cytarabine and daunorubicin (CPX-351) has an infusion schedule that is more amenable to outpatient administration. Outpatient administration of CPX-351 for select patients with close daily monitoring has been implemented via a multidisciplinary team-based model. The feasibility of safely managing AML patients receiving outpatient CPX-351 is being prospectively evaluated in an ongoing phase 4 study. Panelists generally agreed that lower-intensity regimens including venetoclax combined with hypomethylating agents or lowdose cytarabine (LDAC), glasdegib plus LDAC, enasidenib, ivosidenib, and gilteritinib can be administered safely in the outpatient setting for most newly diagnosed AML patients. Venetoclax-based combinations are also promising for outpatient administration but may require risk stratification due to the potential for tumor lysis syndrome (TLS). The proposed algorithm developed to inform consideration of outpatient treatment is focused on consideration of patient fitness, the treatment regimen selected, infrastructure in place to support outpatient administration, and patient/caregiver agreement with the outpatient approach. Educational needs for clinicians and recommendations to overcome knowledge gaps regarding outpatient therapy were also formulated. Outpatient administration of AML therapy is feasible in the appropriate clinical setting and patient. However, further research is needed regarding feasibility, logistics, safety, and patient outcomes including quality of life.

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