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

  • Amanda Lopes Maia Rodrigues Mail School of Medical Sciences, Pará State University, Belém – PA, Brazil
  • Daniel Macêdo do Nascimento School of Medical Sciences, Pará State University, Belém – PA, Brazil
  • Josy Marinho de Lima Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil
  • Marcos Laércio Pontes Reis Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil
  • Lucyana Barbosa Cardoso Leão Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil
  • Murilo Chermont Azavedo School of Medical Sciences, Federal University of Pará, Belém – PA, Brazil
  • Samanta Ribeiro Muccini School of Medical Sciences, Federal University of Pará, Belém – PA, Brazil
  • Polyana Castanha da Silva School of Medical Sciences, Federal University of Pará, Belém – PA, Brazil
  • Thiago Xavier Carneiro Division of Hematology-Oncology and Stem Cell Transplantation, Ophir Loyola Hospital, Belém – PA, Brazil
Keywords:
Acute myeloid leukemia; High drug dose; Chemotherapy; Outpatient care; Low-income population

Abstract

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.

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Published
2020-07-02
How to Cite
1.
Rodrigues A, do Nascimento D, de Lima J, Reis ML, Leão L, Azavedo M, Muccini S, da Silva P, Carneiro T. Safety and Feasibility of Outpatient High Dose Cytarabine for Acute Myeloid Leukemia in the Brazilian Amazon. Int J Hematol Oncol Stem Cell Res. 14(3):151-156.
Section
Original Article(s)