Martínez-Roca Alexandra, Jiménez-Vicente Carlos, Merchán Beatriz, Castaño-Diez Sandra, Zugasti Inés, Brillembourg Helena, Bataller Álex, Guijarro Francesca, Cortés-Bullich Albert, Trigueros Ana, Pérez-Valencia Amanda Isabel, Gallego Cristina, Ballestar Nuria, Rodríguez-Lobato Luis Gerardo, Carcelero Esther, Díaz-Beyá Marina, Esteve Jordi, Fernández-Avilés Francesc
Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain.
Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain.
Cancers (Basel). 2024 Dec 23;16(24):4274. doi: 10.3390/cancers16244274.
Even though venetoclax in combination with azacitidine (VenAza) is considered a low-intensity regimen, its patients present a high incidence of cytopenia and infections during the first courses, making the initial management a challenging phase. This difficulty in our center led to the establishment of an At-Home (AH) program for ramp-up and follow-up patients during the VenAza combination induction phase focused on therapy administration, patient and caregiver education, and management of adverse events (AEs). A total of 70 patients with newly diagnosed acute myeloid leukemia (ND-AML) or relapsed/refractory AML (R/R AML) were treated with VenAza from March 2019 to May 2022. We compared outcomes between patients managed with a hospital-based (inpatient) approach and those managed through the AH program. Despite most patients experiencing grade 3-4 cytopenias (96.9%), the incidence of serious infections and other AEs was comparable between both groups, with no significant difference in febrile neutropenia (42.3% vs. 27.8%, = 0.38). Overall, the AH cohort demonstrated a significantly lower hospital readmission rate after ramp-up (29.5% vs. 84.6%, = 0.001). Moreover, the inpatient cohort's admission days were longer than in the AH cohort (13 vs. 8, = 0.28). AH management was feasible and safe, leading to better resource use, enhanced patient comfort, and improved treatment compliance. The potential of AH programs for managing low-intensity chemotherapy regimens can reduce hospital admissions and subsequently improve patient and caregiver well-being.
尽管维奈克拉联合阿扎胞苷（VenAza）被认为是一种低强度方案，但其患者在最初疗程中出现血细胞减少和感染的发生率很高，这使得初始管理成为一个具有挑战性的阶段。我们中心的这一困难促使建立了一个居家（AH）项目，用于在VenAza联合诱导阶段对患者进行强化治疗和随访，重点是治疗给药、患者及护理人员教育以及不良事件（AE）的管理。2019年3月至2022年5月，共有70例新诊断的急性髓系白血病（ND-AML）或复发/难治性AML（R/R AML）患者接受了VenAza治疗。我们比较了采用基于医院（住院）方法管理的患者与通过AH项目管理的患者的结局。尽管大多数患者经历了3-4级血细胞减少（96.9%），但两组严重感染和其他AE的发生率相当，发热性中性粒细胞减少症无显著差异（42.3%对27.8%，P = 0.38）。总体而言，AH队列在强化治疗后的医院再入院率显著较低（29.5%对84.6%，P = 0.001）。此外，住院队列的住院天数比AH队列更长（13天对8天，P = 0.28）。AH管理是可行且安全的，可导致更好的资源利用、提高患者舒适度并改善治疗依从性。AH项目管理低强度化疗方案的潜力可减少医院入院率，进而改善患者及护理人员的健康状况。
