A comparison of discharge strategies after chemotherapy completion in pediatric patients with acute myeloid leukemia: a report from the Children's Oncology Group. Issue 7 (2nd July 2016)

• Record Type: Journal Article
• Authors: Miller, Tamara P.; Getz, Kelly D.; Kavcic, Marko; Li, Yimei; Huang, Yuan-Shun V.; Sung, Lillian; Alonzo, Todd A.; Gerbing, Robert; Daves, Marla; Horton, Terzah M.; Pulsipher, Michael A.; Pollard, Jessica; Bagatell, Rochelle; Seif, Alix E.; Fisher, Brian T.; Gamis, Alan S.; Aplenc, Richard
• Is Part Of: Leukemia & lymphoma. Volume 57:Issue 7(2016:Jul.)
• Page Start: 1567
• Page End: 1574
• Publication Date: 2016-07-02
• Subjects: Pediatrics -- acute myeloid leukemia -- patient discharge -- morbidity; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.3109/10428194.2015.1088652
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: While most children receive acute myeloid leukemia (AML) chemotherapy as inpatients, there is variability in timing of discharge after chemotherapy completion. This study compared treatment-related morbidity, mortality and cumulative hospitalization in children with AML who were discharged after chemotherapy completion (early discharge) and those who remained hospitalized. Chart abstraction data for 153 early discharge-eligible patients enrolled on a Children's Oncology Group trial were compared by discharge strategy. Targeted toxicities included viridans group streptococcal (VGS) bacteremia, hypoxia and hypotension. Early discharge occurred in 11% of courses post-Induction I. Re-admission occurred in 80–100%, but median hospital stay was 7 days shorter. Patients discharged early had higher rates of VGS (adjusted risk ratio (aRR) = 1.67, 95% CI = 1.11–2.51), hypoxia (aRR = 1.92, 95% CI = 1.06–3.48) and hypotension (aRR = 4.36, 95% CI = 2.01–9.46), but there was no difference in mortality. As pressure increases to shorten hospitalizations, these results have important implications for determining discharge practices in pediatric AML.