Hospital at home enables safe and efficient outpatient management of intensively treated acute myeloid leukemia

Abstract

Abstract Purpose Patients with acute myeloid leukemia (AML) spend a substantial amount of time in hospital while receiving intensive chemotherapy, affecting their quality of life and healthcare costs. This study evaluated the safety of outpatient management of febrile neutropenia with support from hospital at home (HaH). Method Two cohorts of intensively treated patients with AML were retrospectively compared, one from Stockholm ( n = 116) with access to HaH and another from Gothenburg ( n = 49) without HaH support. Primary outcome was incidence of severe complications, defined as death or requirement of higher level of care. Results During cycle 1 (C1), 109 of 116 patients (94%) in Stockholm were discharged, of whom 50 (46%) were readmitted. In Gothenburg, 48 of 49 patients (98%) remained in hospital for the entirety of the neutropenic phase. The incidence of severe complications, including fatal events and requirement of higher level of care, was comparable in the two cohorts. Out of 150 neutropenic episodes (during C1 and C2) among discharged Stockholm patients, febrile neutropenia developed in 130 cases (86.7%). Of these, 38 episodes (29%) were resolved with administration of antibiotics at home only. Conclusion These findings demonstrate that outpatient management of AML patients treated with intensive chemotherapy is feasible and safe when supported by a structured HaH program in close collaboration with the hematology department. Implementation of at-home care has the potential to reduce the burden of prolonged periods of hospitalization for patients with AML and warrants further evaluation in prospective trials.