Experts in AML discuss the impact of outpatient treatment options on the quality of life for patients and review available consolidation treatments.
Katie Colus, PharmD, BCOP: What impact have you noticed from your patients on their quality of life: being able to stay outpatient for a portion of their treatment [as opposed to] a significant hospital stay?
Yehuda Deutsch, MD: Patients are so much happier sleeping at home. When they’re home, they can sleep in their bed. They don’t have to be woken constantly throughout the night. We haven’t done any patient-centered outcomes research on their quality of life. That’s something we definitely can do. But I’m sure that patients would have a much better quality of life. We have data that show patients are able to stay home for more days during their therapy. Some of the data collected show that the patients are able to stay home for almost half the time of their therapy.
We start counting from the day of induction and continue until their count recovery. With CPX-351 [cytarabine, daunorubicin], that count recovery is often a little longer than with 7+3, and it sometimes goes up to 5 to 6 weeks. But of those 5 to 6 weeks, the patients who are getting in the IPOP [inpatient/outpatient] setting, their average days of in-hospital stay was only around 19 days, compared with the patients who are only inpatient. Clearly, they’re in the hospital for 30 to 40 days.
Katie Colus, PharmD, BCOP: There are different intensities and approaches for therapy, as well as different induction strategies or agents that we’ll employ. If induction goes well, we’ll move into a consolidation phase of treatment. Can you both comment on what your current regimens are for consolidation and whether that’s typically administered in an inpatient or outpatient setting?
Yehuda Deutsch, MD: We have to make the decision if the postremission therapy is going to be chemotherapy versus an allogeneic stem cell transplant, but for the patients who are getting chemotherapy, it depends on their molecular cytogenetic risk category, comorbidities, fitness, and what type off induction therapy they receive. For patients who receive a CPX-351 [cytarabine, daunorubicin] type of induction, whether they receive it inpatient or outpatient, we routinely give consolidation therapy as an outpatient. The reason for that is it’s only 2 days of treatment. It’s not continuous infusion. The patients have typically already recovered their blood [cell] counts and are at less risk for infections. They’re usually feeling better, and it’s a lower dose, so the recovery time is much quicker. The standard for consolidation CPX-351 [cytarabine, daunorubicin] would be outpatient therapy.
However, if we’re going to give more than the standard type of consolidation therapy, with high-dose cytarabine, it is often given in a way that you need to be in the hospital. Even though it’s not a continuous infusion over 24 hours, doses are given every 12 hours for about 3 to 5 days. Logistically, it’s very difficult to give that in an outpatient setting. But those patients would stay in the hospital. For the high-dose cytarabine consolidation, the typical way to give it is on days 1, 3, and 5, although there are some studies that show you can give it on days 1, 2, and 3, which is what we do. Patients would be admitted for only 3½ days and then go home. Then they continue the same type of IPOP care, where they’re coming in every other day, sometimes more often, to get lab checks, transfusions, transfusion support, and any other care they need.