The necessity of keeping patients in hospital during neutropenia after high dose chemotherapy is under discussion. A prospective, nonrandomized clinical study was done to examine the safety of ambulatory care in patients undergoing consolidation chemotherapy for acute leukemia, or autologous stem cell transplantation for lymphoma or multiple myeloma. Patients fulfi lling the eligibility criteria were discharged into ambulatory care the day after the last chemotherapy administration, or the day after reinfusion of the stem cells. Patients visited the ambulatory care unit 3 times a week for monitoring of signs, symptoms and laboratory results. During the study period, 165 patients were admitted for 208 chemotherapy cycles. 76 patients in 89 cycles could not be included in the ambulatory care program, most frequently either because their medical situation did not allow for early discharge (58%), or because they had no care giver (14.6%), or had to travel a large distance to the hospital (14.6%). The 89 patients in the ambulatory care group, who underwent 119 cycles of high dose chemotherapy, spent almost 70% of the neutropenic phase at home. 37 out of 89 patients (46 cycles) were never readmitted to the hospital. None of these patients had to be admitted to the intensive care, and there was no treatment related mortality In the hospital group, 2 patients died, one because of pneumonia and one because of invasive aspergillosis. Patients and their caregivers felt safe and comfortable at home, and the vast majority preferred home care over in-hospital treatment. This study demonstrates the safety and feasibility of managing carefully selected patients in an ambulatory care setting after high dose chemotherapy.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)