Burton Hannah, Boussi Leora, Nemirovsky David, Derkach Andriy, Ciervo Jenna, Famulare Christopher, Chin Kuo-Kai, Valtis Yannis, Yisraeli Salman Meira, Patel Kishan, Shah Gunjan L, Goldberg Aaron D, Geyer Mark B, Thompson Meghan C, Tallman Martin S, Stein Eytan M, Cai Sheng F
Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Cancer. 2025 Aug 15;131(16):e70024. doi: 10.1002/cncr.70024.
Administration of intensive induction chemotherapy followed by consolidation with postremission high- or intermediate-dose cytarabine (H/IDAC) remains a standard therapeutic approach in fit patients with nonadverse risk acute myeloid leukemia (AML). Historically, H/IDAC has been administered in the inpatient (IP) rather than outpatient (OP) setting given infection risk, transfusion and supportive care needs, and logistical challenges of OP treatment. However, the financial toxicity associated with IP chemotherapy hospitalization as well as risk of nosocomial infections and improvements in antimicrobial prophylaxis have highlighted the potential role for OP H/IDAC administration.
Accordingly, an OP H/IDAC treatment program was developed at Memorial Sloan Kettering Cancer Center in 2014 using an ambulatory pump system. To investigate the benefits and risks of this approach compared with standard IP H/IDAC administration, a retrospective single-center cohort study was conducted of 198 adult patients with AML who received either IP (59) or OP (139) H/IDAC consolidation.
In the OP-treated group, this approach safely reduced hospitalization days per cycle (median, 0.8 vs 7.5, p < .001) without leading to increased incidence of hospitalization for febrile neutropenia (incidence rate ratio, 1.07, p = .8) or higher rate of major treatment complications. Total cost per cycle was significantly lower for the OP-treated group (median, $14,244 compared to $36,688, p < .001).
In the largest cohort study of adult AML patients receiving OP H/IDAC, OP treatment administration was feasible, led to decreased hospital days and cost savings, and did not impact relapse free or overall survival compared to IP administration.
对于非不良风险的急性髓系白血病（AML）适合患者，先进行强化诱导化疗，随后用缓解后高剂量或中剂量阿糖胞苷（H/IDAC）巩固治疗，仍然是标准的治疗方法。从历史上看，鉴于感染风险、输血及支持治疗需求以及门诊治疗的后勤挑战，H/IDAC一直是在住院环境而非门诊环境中使用。然而，与住院化疗相关的经济毒性以及医院感染风险和抗菌预防措施的改进，凸显了门诊给予H/IDAC的潜在作用。
因此，2014年纪念斯隆凯特琳癌症中心利用门诊输液泵系统制定了门诊H/IDAC治疗方案。为了研究这种方法与标准住院H/IDAC给药相比的益处和风险，对198例接受住院（59例）或门诊（139例）H/IDAC巩固治疗的成年AML患者进行了一项回顾性单中心队列研究。
在门诊治疗组中，这种方法安全地减少了每个周期的住院天数（中位数，0.8天对7.5天，p <.001），而没有导致发热性中性粒细胞减少症住院发生率增加（发生率比，1.07，p =.8）或主要治疗并发症发生率更高。门诊治疗组每个周期的总成本显著更低（中位数，14,244美元，相比之下住院组为36,688美元，p <.001）。
在接受门诊H/IDAC的成年AML患者的最大队列研究中，门诊治疗是可行的，导致住院天数减少和成本节约，与住院给药相比，不影响无复发生存率或总生存率。
