Safety and Feasibility of Outpatient High Dose Cytarabine for Acute Myeloid Leukemia in the Brazilian Amazon

• Main Authors: Amanda Lopes Maia Rodrigues, Daniel Macêdo do Nascimento, Josy Marinho de Lima, Marcos Laércio Pontes Reis, Lucyana Barbosa Cardoso Leão, Murilo Chermont Azavedo, Samanta Ribeiro Muccini, Polyana Castanha da Silva, Thiago Xavier Carneiro
• Format: Article
• Language: English
• Published: Tehran University of Medical Sciences 2020-07-01
• Series: International Journal of Hematology-Oncology and Stem Cell Research
• Subjects: Acute myeloid leukemia; High drug dose; Chemotherapy; Outpatient care; Low-income population
• Online Access: https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1179

Background: The attempt to manage patients with acute myeloid leukemia as outpatients has become increasingly common due to high hospitalization costs, low availability for beds and patient preference. Publications on the subject are scarce, especially in low-income regions and the safety in this population remains to be determined. The present study aims to assess the safety of consolidation with high dose cytarabine in the outpatient setting. Materials and Methods: We retrospectively analyzed 39 patients who underwent consolidation with high-dose cytarabine, between 2009 and 2018, at Ophir Loyola Hospital, in Belém, Brazil. Patients treated after 2015 were given high-dose cytarabine as outpatients due to the decision of medical staff. Results: 27 patients received 76 cycles of cytarabine as outpatients; males were 48.14% of the total population, with a median age of approximately 45 years. The occurrence of delay between cycles was significantly lower among outpatients (48.14% vs. 83.33%, p = 0.04). There was no difference between relapse rates, transfusion requirements and non-relapse mortality between both groups. Hospitalization was required in 40.74% of patients during outpatient cycles and 18.51% of blood cultures were positive for pathogens. Non-relapse mortality was significantly higher among patients above 50 years old and treated on an outpatient basis (44.4% vs. 5.60%, p = 0.03). Conclusion: High-dose cytarabine administration on an outpatient basis appears to be safe and effective in a low-income population at the Brazilian Amazon region, but toxicity seems to be increased for patients older than 50 years.