Allan D S, Buckstein R, Imrie K R
University of Western Ontario, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Leuk Lymphoma. 2001 Jul;42(3):339-46. doi: 10.3109/10428190109064590.
Treatment of acute myeloid leukemia (AML) involves aggressive myelosuppressive chemotherapy that is generally administered on an inpatient basis. In our centre, AML therapy has been initiated in hospital and followed by early outpatient supportive care according to guidelines established in 1996. We conducted a review of all patients presenting with AML in our centre between January 1996 and July 1998 to evaluate the safety and feasibility of early outpatient supportive care. Nineteen consecutive patients treated with induction chemotherapy were analyzed. Patients were treated with cytosine arabinoside and an anthracycline as aggressive AML induction therapy with the intent for early discharge. Ten patients (53%) were discharged within 10 days of starting induction chemotherapy (median 4.5 days). Reasons for remaining in hospital included sepsis, serious medical complications, and social and geographic factors. Patients discharged early had a median of 1.5 readmissions (range 0-3), but had 30% fewer in-hospital days than inpatients (p = 0.03), and 57% fewer days of in-hospital antibiotic therapy (p = 0.01). There were no significant differences in transfusion requirements or episodes of febrile neutropenia between the two groups. Thirty-one cycles of consolidation therapy were administered to the 18 patients who survived induction. Early discharge from hospital was achieved for 30 cycles (97%). Nine cycles of consolidation chemotherapy were delivered using outpatient intravenous infusion pumps (29%). This study supports the feasibility and safety of early discharge and outpatient supportive care following chemotherapy for AML.
急性髓系白血病（AML）的治疗包括积极的骨髓抑制化疗，通常在住院基础上进行。在我们中心，AML治疗于1996年开始在医院启动，随后根据当年制定的指南进行早期门诊支持性护理。我们回顾了1996年1月至1998年7月期间在我们中心就诊的所有AML患者，以评估早期门诊支持性护理的安全性和可行性。对19例接受诱导化疗的连续患者进行了分析。患者接受阿糖胞苷和蒽环类药物作为积极的AML诱导治疗，目的是早期出院。10例患者（53%）在开始诱导化疗后10天内出院（中位时间4.5天）。住院的原因包括败血症、严重的医疗并发症以及社会和地理因素。早期出院的患者中位再入院次数为1.5次（范围0 - 3次），但住院天数比住院患者少30%（p = 0.03），住院抗生素治疗天数少57%（p = 0.01）。两组在输血需求或发热性中性粒细胞减少发作方面无显著差异。对18例诱导治疗存活的患者进行了31个周期的巩固治疗。30个周期（97%）实现了早期出院。9个周期的巩固化疗使用门诊静脉输液泵进行（29%）。本研究支持AML化疗后早期出院和门诊支持性护理的可行性和安全性。
