Department of Haematology, National University Hospital, Copenhagen, Denmark.
Eur J Haematol. 2010 Apr;84(4):316-22. doi: 10.1111/j.1600-0609.2009.01397.x. Epub 2009 Dec 11.
Traditionally, patients with acute leukaemia are admitted to hospital during chemotherapy-induced pancytopenia, although a few recent reports have reported the feasibility and safety of outpatient treatment. We have developed an outpatient treatment programme for patients with acute leukaemia incorporating comprehensive patient education for self-care management at home during pancytopenia and involvement of patients in care of their tunnelled central venous catheter (CVC). During neutropenia, patients are treated with prophylactic ciprofloxacine, amoxicillin/clavulanic acid and fluconazole. Herein, we report the results of outpatient treatment of 60 patients with acute leukaemia (54 with acute myeloid leukaemia) followed prospectively in the period from March 2004 to 2007. After induction chemotherapy, outpatient treatment was possible after 48 of 73 induction courses, with no readmission in 19 of these (40%). A total of 129 consolidation courses were administered with outpatient treatment following 116 of these, with no readmission in 69 (59%). The median number of days spent at home with neutrophils below 0.5 x 10(9)/L was 8 d per course following induction and 12 d following consolidation chemotherapy. The predominant cause of readmission was neutropenic fever, in most instances of unknown origin. Coagulase-negative staphylococci and Enterococcus faecium were the most frequently identified bacteria in blood cultures, whereas only four positive blood cultures with multiresistant Escherichia coli were identified in the entire patient cohort, the latter exclusively observed in patients receiving antibiotic prophylaxis. The majority of the patients were able to take care of their CVC including change in dressing and heparin flushing. There were 12 CVC-related infections. There were no treatment-related deaths. We conclude that outpatient treatment of patients with acute leukaemia is feasible and safe.
传统上，接受化疗诱导性全血细胞减少症的急性白血病患者会住院治疗，尽管最近有一些报告报道了门诊治疗的可行性和安全性。我们为急性白血病患者开发了一个门诊治疗方案，包括在全血细胞减少症期间对患者进行全面的自我护理管理教育，并让患者参与其隧道式中央静脉导管（CVC）的护理。在中性粒细胞减少症期间，患者接受预防性环丙沙星、阿莫西林/克拉维酸和氟康唑治疗。在此，我们报告了 2004 年 3 月至 2007 年期间前瞻性随访的 60 例急性白血病（54 例急性髓系白血病）患者的门诊治疗结果。诱导化疗后，48/73 例诱导疗程可进行门诊治疗，其中 19 例（40%）无需再次入院。共进行了 129 次巩固化疗，其中 116 次采用门诊治疗，其中 69 次（59%）无需再次入院。诱导后中性粒细胞计数低于 0.5 x 10(9)/L 的居家天数中位数为 8 天/疗程，巩固化疗后为 12 天。再次入院的主要原因是中性粒细胞减少性发热，大多数情况下原因不明。凝固酶阴性葡萄球菌和粪肠球菌是血液培养中最常发现的细菌，而在整个患者队列中仅发现 4 例对多粘菌素耐药的大肠埃希菌阳性血培养，后者仅在接受抗生素预防的患者中观察到。大多数患者能够照顾他们的 CVC，包括更换敷料和肝素冲洗。发生了 12 例 CVC 相关感染。没有与治疗相关的死亡。我们得出结论，门诊治疗急性白血病患者是可行且安全的。
